Individual provider Active NPI

Jennalynn Campos, RPAC

  • Physician Assistant
  • Mineola, NY
National Provider Identifier
1992974315
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
23012447 Issued in NY
Practice address
300 Old Country Rd
Mineola, NY 11501-4198
Phone
(516) 280-2599
Fax
(516) 280-2597
NPI assigned
Feb 29, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 23012447 NY Primary

Addresses

Primary practice location

300 Old Country Rd
Mineola, NY 11501-4198

Mailing address

300 Old Country Rd Ste 211
Mineola, NY 11501-4112
Phone (516) 280-2599

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081024000393 NY Practitioner - Physician Assistant 3577621283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Li-Queens Medical Associates, PCGroup PAC ID 8628134921, 4 clinicians

Practice addresses (Care Compare)

300 Old Country Rd
Mineola, NY 11501-4112
Phone (516) 280-2599

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
012447NYMDChiropractor
23012447NYMDPhysician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784160000000",
    "number": "1992974315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 OLD COUNTRY RD STE 211",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014112",
            "telephone_number": "516-280-2599",
            "fax_number": "516-280-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OLD COUNTRY RD",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014198",
            "telephone_number": "516-280-2599",
            "fax_number": "516-280-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPOS",
        "first_name": "JENNALYNN",
        "name_prefix": "Ms.",
        "credential": "RPAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-29",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "23012447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.