340B Drug Pricing Program Database


DSH330195 LONG ISLAND JEWISH MEDICAL CENTER (Active) - information as of 6/3/2025 12:04:08 PM

Main Details
LONG ISLAND JEWISH MEDICAL CENTER
Disproportionate Share Hospital
Yes
DSH330195
330195


Additional Details
Active
6/5/2007
7/1/2007
6/6/2007
8/19/2024

Contacts

Northwell Health
Michele L Cusack, Executive Vice President
(516) 321-6058

Northwell
Onisis Stefas, VP of Pharmacy Operations
(516) 719-5720

Addresses

270-05 76TH AVENUE
NEW HYDE PARK, NY 11040

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NY05069154,05099885,04133506,3313980,00243903,029988871285641514,1871024455,1174926406,1982611190,1174530349,1346603107,1467695023
ALLON0195N1285641514,1982611190,1174530349,1174926406,1871024455,1346603107
AR2397391051285641514,1982611190,1174530349,1174926406,1871024455,1346603107
AZ5982101285641514,1982611190,1174530349,1174926406,1871024455,1346603107
CA12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
CO90001822811285641514,1982611190,1174530349,1174926406,1871024455,1346603107
CT003129401,0080954571285641514,1982611190,1174530349,1174926406,1871024455,1346603107
DC601781561285641514,1982611190,1174530349,1174926406,1871024455,1346603107
DE12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
FL0920860001285641514,1982611190,1174530349,1174926406,1871024455,1346603107
GA000105729A1285641514,1982611190,1174530349,1174926406,1871024455,1346603107
IA12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
IL12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
IN200827120A1285641514,1982611190,1174530349,1174926406,1871024455,1346603107
KY015000401285641514,1982611190,1174530349,1174926406,1871024455,1346603107
MA110026857C1285641514,1982611190,1174530349,1174926406,1871024455,1346603107
MD2833352001285641514,1982611190,1174530349,1174926406,1871024455,1346603107
ME1606700001285641514,1982611190,1174530349,1174926406,1871024455,1346603107
MI12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
MN1992171001285641514,1982611190,1174530349,1174926406,1871024455,1346603107
MO12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
MS000967361285641514,1982611190,1174530349,1174926406,1871024455,1346603107
NC12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
NE112241326001285641514,1982611190,1174530349,1174926406,1871024455,1346603107
NH31043401285641514,1982611190,1174530349,1174926406,1871024455,1346603107
NJ41573031285641514,1982611190,1174530349,1174926406,1871024455,1346603107
NMA84351285641514,1982611190,1174530349,1174926406,1871024455,1346603107
NV0012883871285641514,1982611190,1174530349,1174926406,1871024455,1346603107
OH06080331285641514,1982611190,1174530349,1174926406,1871024455,1346603107
OK100689170A1285641514,1982611190,1174530349,1174926406,1871024455,1346603107
OR12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
PA1007620400005,10076204000061285641514,1982611190,1174530349,1174926406,1871024455,1346603107
RIOP301951285641514,1982611190,1174530349,1174926406,1871024455,1346603107
SC10858B1285641514,1982611190,1174530349,1174926406,1871024455,1346603107
TNQ0342521285641514,1982611190,1174530349,1174926406,1871024455,1346603107
TX0724858011285641514,1982611190,1174530349,1174926406,1871024455,1346603107
UT12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
VA12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
VT03301951285641514,1982611190,1174530349,1174926406,1871024455,1346603107
WA12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
WI12856415141285641514,1982611190,1174530349,1174926406,1871024455,1346603107
Shipping Addresses

LONG ISLAND JEWISH MEDICAL CENTER
270-05 76TH AVE
NEW HYDE PARK, NY 11040

LONG ISLAND JEWISH FOREST HILLS
102-01 66TH RD
FOREST HILLS, NY 11375

ZUCKER HILLSIDE HOSPITAL
75-59 263RD ST
GLEN OAKS, NY 11004

MONTER CANCER CENTER
450 LAKEVILLE ROAD
LAKE SUCCESS, NY 11042

LONG ISLAND JEWISH VALLEY STREAM
900 FRANKLIN AVE
VALLEY STREAM, NY 11580

Safecor Health
317 New Boston Street
Woburn, MA 01801
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACARIAHEALTH PHARMACY #12, INC.5 SKYLINE DR STE 240
HAWTHORNENY10532-216610/16/202001/01/2021 01/08/202501/08/2025
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/15/202010/01/2020  10/30/2024
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/15/202010/01/2020  10/30/2024
Contract DetailACCREDO HEALTH GROUP INC422 GALLIMORE DAIRY RD SUITE A
GREENSBORONC2740907/07/202310/01/2023 01/11/202401/12/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/15/202010/01/2020  10/30/2024
Contract DetailACCREDO HEALTH GROUP, INC.45 ROUTE 46 EAST SUITE 609
PINE BROOKNJ0705804/18/202207/01/2022  10/30/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282201/12/202404/01/2024  10/30/2024
Contract DetailAHG OF NEW YORK, INCDBA: ACCREDO 125 CLEARBROOK RD STE 122
ELMSFORDNY10523-111910/05/202301/01/2024  10/30/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526107/18/202310/01/2023  10/17/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620310/01/202401/01/2025  01/01/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771310/01/202401/01/2025  01/01/2025
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/16/202001/01/2021  01/01/2021
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/16/202001/01/2021  01/01/2021
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/16/202001/01/2021  01/01/2021
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/16/202001/01/2021  01/01/2021
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/16/202001/01/2021  01/01/2021
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/16/202001/01/2021  01/01/2021
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/16/202001/01/2021  01/01/2021
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/16/202001/01/2021  01/01/2021
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/16/202001/01/2021  01/01/2021
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/16/202001/01/2021  01/01/2021
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/15/202101/01/2022  01/01/2022
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/15/202101/01/2022  01/01/2022
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/16/202001/01/2021  01/01/2021
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268307/15/202010/01/2020 11/30/202211/30/2022
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/15/202010/01/2020  10/30/2024
Contract DetailLONG ISLAND JEWISH MEDICAL CENTERD/B/A VIVO HEALTH PHARMACY AT CFAM 270-05 76TH AVE
NEW HYDE PARKNY1104001/09/201504/01/2015 07/10/201507/25/2017
Contract DetailLONG ISLAND JEWISH MEDICAL CENTER AT HOMVIVO HEALTH PHARMACY AT HOME 225 COMMUNITY DR STE 140
GREAT NECKNY11021-550601/12/201804/01/201801/01/2024 11/20/2023
Contract DetailNORTH SHORE UNIVERSITY HOSPITALDBA VIVO HEALTH PHARMACY AT MANHASSET 300 COMMUNITY DRIVE
MANHASSETNY1103007/07/202310/01/202301/01/2024 11/20/2023
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 11403 BLUEGRASS PARKWAY
SUITE 400 		LOUISVILLEKY40299-239810/17/202301/01/2024  10/30/2024
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191307/15/202010/01/2020 10/14/202010/15/2020
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191309/15/202310/01/2023  10/30/2024
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260109/15/202310/01/2023  10/30/2024
Contract DetailOPTUM INFUSION SERVICES 101, INC.931 CONKLIN ST STE D
FARMINGDALENY11735-242907/15/202010/01/2020  10/30/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135107/15/202010/01/2020  10/30/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC4000 CHEMICAL RD STE 100
PLYMOUTH MEETINGPA1946210/12/202101/01/2022  10/30/2024
Contract DetailOPTUM INFUSION SERVICES 550, LLC20 COMMERCE WAY SUITE 2
WOBURNMA0180110/06/202201/01/2023  10/30/2024
Contract DetailOPTUM INFUSION SERVICES 554, INC.2805 VETERANS MEMORIAL HWY SUITES 19-22
RONKONKOMANY1177910/12/202101/01/2022 10/06/202210/06/2022
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705807/15/202010/01/2020  10/01/2020
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/13/202201/24/2022  10/30/2024
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520409/15/202310/01/2023  10/30/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/15/202010/01/2020  10/30/2024
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824910/12/202101/01/2022  01/01/2022
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/15/202010/01/2020  10/30/2024
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110107/15/202010/01/2020  10/30/2024
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/15/202010/01/2020  10/30/2024
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/15/202010/01/2020  10/30/2024
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660807/15/202010/01/2020 10/06/202210/06/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/16/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/16/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/16/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY # 2919 126 EIGHTH AVE.
NEW YORKNY1001110/15/202101/01/2022  01/01/2022
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255007/18/202310/01/2023  10/17/2023
Contract DetailREGIONCARE INC200 COMMUNITY DR
GREAT NECKNY11021-551010/18/202201/01/2023  01/01/2023
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104207/15/202010/01/2020  10/01/2020
Contract DetailSORKIN'S RX LTDD/B/A CAREMED PHARMACEUTICAL SERVICES 1985 MARCUS AVE STE 130
NEW HYDE PARKNY11042-202407/15/202010/01/2020 04/06/202204/12/2022
Contract DetailTRINITY HOMECARE, L.L.C.OPTION CARE 4805 METROPOLITAN AVE STE 3-02
RIDGEWOODNY1138510/17/202301/01/2024  10/30/2024
Contract DetailTRUE NORTH HEALTH PHARMACY, INCDBA: VIVO HEALTH PHARMACY AT CFAM 450 LAKEVILLE RD
LAKE SUCCESSNY1104207/17/201510/01/201501/01/2024 11/20/2023
Contract DetailTRUE NORTH HEALTH PHARMACY, INC.DBA: VIVO HEALTH SPECIALTY PHARMACY 225 COMMUNITY DR STE 100
GREAT NECKNY11021-550607/14/201510/01/201501/01/2024 11/20/2023
Contract DetailTRUE NORTH HEALTH PHARMACY, INC.DBA: VIVO HEALTH PHARMACY AT REGO PARK 95-25 QUEENS BLVD.
SUITE GFL03 		REGO PARKNY1137410/12/202301/01/2024  01/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 02055 109-62 FRANCIS LEWIS BLVD
QUEENS VILLAGENY1142907/19/202110/01/2021 02/22/202402/23/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05051 21914 MERRICK BLVD
LAURELTONNY1141307/19/202110/01/2021 02/22/202402/23/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04565 12704 GUY R BREWER BLVD
JAMAICANY1143407/19/202110/01/2021 02/22/202402/23/2024
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH330195AChildDSHLONG ISLAND JEWISH MEDICAL CENTERZUCKER HILLSIDE HOSPITAL - METHADONE CLINIC75-59 263RD ST.GLEN OAKSNYActive
DSH330195AAChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital-Multi Speciality Clinic Rego Park / Ob/Gyn & Prenatal Care95-25 Queens BlvdRego ParkNYActive
DSH330195ABChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / CAT Scan102-01 66th RoadForest HillsNYActive
DSH330195ACChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / MRI102-01 66th RoadForest HillsNYActive
DSH330195ADChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / Diagnostic Radiology102-01 66th RoadForest HillsNYActive
DSH330195AEChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / Interventional/Special Procedures102-01 66th RoadForest HillsNYActive
DSH330195AFChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / Endoscopy102-01 66th RoadForest HillsNYActive
DSH330195AGChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / Ambulatory Surgery102-01 66th RoadForest HillsNYActive
DSH330195AHChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / Emergency Deptartment102-01 66th RoadForest HillsNYActive
DSH330195AJChildDSHLONG ISLAND JEWISH MEDICAL CENTERNorthwell Health Cancer Institute - Great South Bay440 East Main StreetBayshoreNYActive
DSH330195AKChildDSHLONG ISLAND JEWISH MEDICAL CENTERSCHOOL BASED HC - John Adams101-01 Rockaway BlvdOzone ParkNYActive
DSH330195ALChildDSHLONG ISLAND JEWISH MEDICAL CENTERLIJ Center for Advanced Medicine-Radiation Oncology450 Lakeville RoadLake SuccessNYActive
DSH330195AMChildDSHLONG ISLAND JEWISH MEDICAL CENTERProject Outreach600 Hempstead TurnpikeWest HempsteadNYActive
DSH330195ANChildDSHLONG ISLAND JEWISH MEDICAL CENTERGarden City Treatment Center711 Stewart AvenueGarden CityNYActive
DSH330195APChildDSHLONG ISLAND JEWISH MEDICAL CENTERFar Rockaway Treatment Center1600 Central AvenueFar RockawayNYActive
DSH330195AQChildDSHLONG ISLAND JEWISH MEDICAL CENTERNorthwell Health Imaging at Bay Shore-Radiology Diagnostic440 East Main StreetBay ShoreNYActive
DSH330195ARChildDSHLONG ISLAND JEWISH MEDICAL CENTERNorthwell Health Imaging at Bay Shore - Radioisotope 440 East Main StreetBay ShoreNYActive
DSH330195ASChildDSHLONG ISLAND JEWISH MEDICAL CENTERNorthwell Health Imaging at Bay Shore - MRI440 East Main StreetBay ShoreNYActive
DSH330195ATChildDSHLONG ISLAND JEWISH MEDICAL CENTERLIJMC/ Medicine Specialties at Glen Oaks - Clinic25611 Union TurnpikeGlen OaksNYActive
DSH330195AUChildDSHLONG ISLAND JEWISH MEDICAL CENTERNorthwell Health Cancer Center - Cancer Treatment Services270 Pulaski Rd.GreenlawnNYActive
DSH330195AVChildDSHLONG ISLAND JEWISH MEDICAL CENTERSBHC - August Martin - School-based Health Center156-10 Baisley BlvdJamaicaNYActive
DSH330195AWChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / EHS - Employee Health Services102-01 66th RoadForest HillsNYTerminated
DSH330195AXChildDSHLONG ISLAND JEWISH MEDICAL CENTERHearing and Speech Center - Clinic430 Lakeville RoadNew Hyde ParkNYActive
DSH330195AYChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / Pre-Surgical Testing - Pre Surgical Testing102-01 66th RoadForest HillsNYActive
DSH330195AZChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hospital / Women's Health - Ultrasound Diagnostic102-01 66th RoadForest HillsNYTerminated
DSH330195BChildDSHLONG ISLAND JEWISH MEDICAL CENTERZuckerberg Cancer Center450 LAKEVILLE ROADLAKE SUCCESSNYActive
DSH330195BAChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Valley Stream / EKG/ECHO - Electrocardiology900 Franklin AveValley StreamNYActive
DSH330195BBChildDSHLONG ISLAND JEWISH MEDICAL CENTERZucker Hillside/ Personalized Recovery Oriented Services - All Other OASAS Programs O/P205-07 Hillside AveHollisNYActive
DSH330195BCChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Valley Stream / Outpatient Lab - Laboratory900 Franklin AveValley StreamNYActive
DSH330195BDChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Valley Stream / Pre Surgical Testing - Pre Surgical Testing900 Franklin AveValley StreamNYActive
DSH330195BEChildDSHLONG ISLAND JEWISH MEDICAL CENTERZucker Hillside/ Martin Van Buren High School Clinic - Mental Health Clinic230-17 Hillside AveQueens VillageNYActive
DSH330195BFChildDSHLONG ISLAND JEWISH MEDICAL CENTERSTARS Transitions/ LIJOP PSY/Social Work Svc Tran - Physical Therapy1554 Northern BlvdManhassetNYActive
DSH330195BGChildDSHLONG ISLAND JEWISH MEDICAL CENTERSTARS Transitions/ LIJOP Occupat Therapy Trans - Physical Therapy1554 Northern BlvdManhassetNYActive
DSH330195BHChildDSHLONG ISLAND JEWISH MEDICAL CENTERZUCKER HILLSIDE HOSPITAL - DAERHS - ALL OTHER OASIS PROGRAMS75-59 263RD STREETGLEN OAKSNYActive
DSH330195BJChildDSHLONG ISLAND JEWISH MEDICAL CENTERZUCKER HILLSIDE HOSPITAL - ELECTROCONVULSIVE THERAPY CLINIC - MENTAL HEALTH CLINIC75-59 263RD STREETGLEN OAKSNYActive
DSH330195BKChildDSHLONG ISLAND JEWISH MEDICAL CENTERZUCKER HILLSIDE HOSPITAL - MEDICAL SPECIALTIES CLINIC - MENTAL HEALTH CLINIC75-59 263RD STREETGLEN OAKSNYActive
DSH330195BLChildDSHLONG ISLAND JEWISH MEDICAL CENTERZUCKER HILLSIDE HOSPITAL - AMBULATORY CARE - MENTAL HEALTH CLINIC75-59 263RD STREETGLEN OAKSNYActive
DSH330195BMChildDSHLONG ISLAND JEWISH MEDICAL CENTERZUCKER HILLSIDE HOSPITAL - Psych Centers - MENTAL HEALTH CLINIC75-59 263RD STREETGLEN OAKSNYActive
DSH330195BNChildDSHLONG ISLAND JEWISH MEDICAL CENTERZUCKER HILLSIDE HOSPITAL - CTC CLINIC - MENTAL HEALTH CLINIC75-59 263RD STREETGLEN OAKSNYActive
DSH330195BPChildDSHLONG ISLAND JEWISH MEDICAL CENTERZUCKER HILLSIDE HOSPITAL - CRISIS INTERVENTION - MENTAL HEALTH CLINIC75-59 263RD STREETGLEN OAKSNYActive
DSH330195BQChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Extension Urology Clinic - Urology95-25 Queens Boulevard 2nd floorRego ParkNYActive
DSH330195BRChildDSHLONG ISLAND JEWISH MEDICAL CENTERBACKSTRETCH CLINIC AT BELMONT RACETRACK - Clinic2150 HEMPSTEAD TURNPIKE COTTAGE 58CBELMONTNYActive
DSH330195BSChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Extension Clinic - Peds Immunology95-25 Queens BlvdRego ParkNYActive
DSH330195BTChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital - OBS Check & Call - OBS Check & Call102-01 66th RoadForest HillsNYActive
DSH330195BUChildDSHLONG ISLAND JEWISH MEDICAL CENTERZucker Hillside Hospital - Perinatal75-59 263rd St.Glen OaksNYActive
DSH330195BVChildDSHLONG ISLAND JEWISH MEDICAL CENTERZucker Hillside Hospital - OCD75-59 263rd St.Glen OaksNYActive
DSH330195BWChildDSHLONG ISLAND JEWISH MEDICAL CENTERZucker Hillside Hospital - Early Treatment75-59 263rd St.Glen OaksNYActive
DSH330195BXChildDSHLONG ISLAND JEWISH MEDICAL CENTERZucker Hillside Hospital - Bipolar75-59 263rd St.Glen OaksNYActive
DSH330195BYChildDSHLONG ISLAND JEWISH MEDICAL CENTERZucker Hillside Hospital - On Track75-59 263rd St.Glen OaksNYActive
DSH330195BZChildDSHLONG ISLAND JEWISH MEDICAL CENTERZucker Hillside Hospital - College Partnership75-59 263rd St.Glen OaksNYActive
DSH330195CChildDSHLONG ISLAND JEWISH MEDICAL CENTERSBHC - Franklin K Lane999 Jamaica AveBrooklynNYActive
DSH330195CAChildDSHLONG ISLAND JEWISH MEDICAL CENTERZUCKER HILLSIDE HOSPITAL - Ketamine Infusion Services75-59 263RD STGLEN OAKSNYActive
DSH330195CBChildDSHLONG ISLAND JEWISH MEDICAL CENTERQueens Cancer Center95-25 Queens BlvdRego ParkNYActive
DSH330195DChildDSHLONG ISLAND JEWISH MEDICAL CENTERNorth Shore - LIJ Medical Group Urgent Care Center95-25 Queens BlvdRego ParkNYTerminated
DSH330195EChildDSHLONG ISLAND JEWISH MEDICAL CENTERLIJ Center for Advanced Medicine-Recovery Room Ambulatory Surgery450 Lakeville RdLake SuccessNYActive
DSH330195FChildDSHLONG ISLAND JEWISH MEDICAL CENTERFar Rockaway HS Clinic SBHC821 Bay 25th StreetFar RockawayNYActive
DSH330195GChildDSHLONG ISLAND JEWISH MEDICAL CENTERBrian Picolo MS53 Clinic SBHC1045 Nameoke StreetFar RockawayNYActive
DSH330195HChildDSHLONG ISLAND JEWISH MEDICAL CENTERPediatric & Adolescent Medicine Clinic / General Pediatrics410 Lakeville RdNew Hyde ParkNYActive
DSH330195JChildDSHLONG ISLAND JEWISH MEDICAL CENTERPediatric & Adolescent Medicine Clinic / Adolescent Medicine410 Lakeville RdNew Hyde ParkNYActive
DSH330195KChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Eye Care Center600 Northern BlvdGreat NeckNYTerminated
DSH330195LChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Medical Center LIJ Satellite Dialysis Center220-22 Hillside AvenueQueens VillageNYActive
DSH330195MChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Rego Park Multi-Specialty Clinic / Nuclear Stress95-25 Queens BlvdRego ParkNYTerminated
DSH330195NChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Hospital / Diagnostic Cardiology Echo102-01 66th RoadForest HillsNYActive
DSH330195PChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Valley Stream / Outpatient Recovery Room900 Franklin AveValley StreamNYActive
DSH330195QChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Valley Stream / Radiology900 FRANKLIN AVE.Valley StreamNYActive
DSH330195RChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Valley Stream / HYPERBARIC OXYGEN THERAPY900 FRANKLIN AVE.Valley StreamNYActive
DSH330195SChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Valley Stream / Wound Care900 FRANKLIN AVE.Valley StreamNYActive
DSH330195TChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Valley Stream / Ambulatory Surgery900 FRANKLIN AVE.Valley StreamNYActive
DSH330195UChildDSHLONG ISLAND JEWISH MEDICAL CENTERLong Island Jewish Valley Stream / Emergency Department900 FRANKLIN AVE.Valley StreamNYActive
DSH330195VChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Rego Park Multi-Specialty Clinic / Internal Medicine95-25 Queens BlvdRego ParkNYActive
DSH330195WChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Rego Park Multi-Specialty Clinic / General Surgery95-25 Queens BlvdRego ParkNYActive
DSH330195XChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Rego Park Multi-Specialty Clinic / Cardiology95-25 Queens BlvdRego ParkNYTerminated
DSH330195YChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills Rego Park Multi-Specialty Clinic / Wound Care95-25 Queens BlvdRego ParkNYActive
DSH330195ZChildDSHLONG ISLAND JEWISH MEDICAL CENTERForest Hills-Rego Park Multi-Specialty Clinic / Podiatry95-25 Queens BlvdRego ParkNYActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False10/3/2024 10:01 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 331398010/3/2024 10:01 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request NY10/3/2024 10:01 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 146769502310/3/2024 10:01 AM
Medicaid BillingNPI: StateInsertGroup Change Request NY10/3/2024 10:01 AM
Medicaid BillingMedicaid: NumberDeleteChange Request03313980 (NY) 9/25/2024 1:31 PM
Medicaid BillingMedicaid: NumberDeleteChange Request05431874 (NY) 9/25/2024 1:31 PM
Medicaid BillingMedicaid: NumberDeleteChange Request04634960 (NY) 9/25/2024 1:31 PM
Medicaid BillingMedicaid: NumberDeleteChange Request04633703 (NY) 9/25/2024 1:31 PM
Medicaid BillingNPI: NumberDeleteChange Request1669854832 (NY) 9/25/2024 1:31 PM
Medicaid BillingNPI: NumberDeleteChange Request1730523549 (NY) 9/25/2024 1:31 PM
Medicaid BillingNPI: NumberDeleteChange Request1851807929 (NY) 9/25/2024 1:31 PM
Medicaid BillingNPI: NumberDeleteChange Request1467695023 (NY) 9/25/2024 1:31 PM
DetailsLast Recertification DateUpdateRecertification8/23/2023 11:41:03 AM8/19/2024 3:49:51 PM8/19/2024 3:49 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False2/28/2024 2:56 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 0080954572/28/2024 2:56 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request CT2/28/2024 2:56 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False2/28/2024 2:56 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 10076204000062/28/2024 2:56 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request PA2/28/2024 2:56 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/13/2023 1:07 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0331398012/13/2023 1:07 PM
Medicaid BillingMedicaid: StateInsertChange Request NY12/13/2023 1:07 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/13/2023 1:07 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0543187412/13/2023 1:07 PM
Medicaid BillingMedicaid: StateInsertChange Request NY12/13/2023 1:07 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/13/2023 1:07 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0463496012/13/2023 1:07 PM
Medicaid BillingMedicaid: StateInsertChange Request NY12/13/2023 1:07 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/13/2023 1:07 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0463370312/13/2023 1:07 PM
Medicaid BillingMedicaid: StateInsertChange Request NY12/13/2023 1:07 PM
Medicaid BillingNPI: NumberInsertChange Request 166985483212/13/2023 1:07 PM
Medicaid BillingNPI: StateInsertChange Request NY12/13/2023 1:07 PM
Medicaid BillingNPI: NumberInsertChange Request 173052354912/13/2023 1:07 PM
Medicaid BillingNPI: StateInsertChange Request NY12/13/2023 1:07 PM
Medicaid BillingNPI: NumberInsertChange Request 185180792912/13/2023 1:07 PM
Medicaid BillingNPI: StateInsertChange Request NY12/13/2023 1:07 PM
Medicaid BillingNPI: NumberInsertChange Request 146769502312/13/2023 1:07 PM
Medicaid BillingNPI: StateInsertChange Request NY12/13/2023 1:07 PM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request GA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request GA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request GA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request GA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request GA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request GA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MS11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MS11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MS11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MS11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MS11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MS11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NV11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NV11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NV11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NV11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NV11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NV11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NY11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NY11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NY11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request KY11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request KY11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request KY11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request KY11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request KY11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request KY11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TX11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TX11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TX11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TX11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TX11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TX11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request FL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request FL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request FL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request FL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request FL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request FL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OK11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OK11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OK11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OK11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OK11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OK11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request PA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request PA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request PA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request PA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request PA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request PA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request SC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request SC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request SC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request SC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request SC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request SC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DE11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request OR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request UT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request UT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request UT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request UT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request UT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request UT11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request VA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WA11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request WI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request ME11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request ME11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request ME11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request ME11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request ME11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request ME11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request IN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AR11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MD11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MD11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MD11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MD11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MD11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request MD11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NH11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NJ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NJ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NJ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NJ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NJ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NJ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AZ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AZ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AZ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AZ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AZ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AZ11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request DC11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request CO11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NM11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NM11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NM11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NM11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NM11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request NM11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request AL11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request RI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request RI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request RI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request RI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request RI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request RI11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 128564151411/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 198261119011/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117453034911/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 117492640611/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 187102445511/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TN11/30/2023 11:12 AM
Medicaid BillingNPI: NumberInsertChange Request 134660310711/30/2023 11:12 AM
Medicaid BillingNPI: StateInsertChange Request TN11/30/2023 11:12 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestCusack, Michele L SVP & CFO Northwell Health 5163216058Cusack, Michele L Executive Vice President Northwell Health 51632160589/6/2023 3:19 PM
DetailsLast Recertification DateUpdateRecertification8/26/2022 12:49:48 PM8/23/2023 11:41:03 AM8/23/2023 11:41 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/21/2023 10:25 AM
Medicaid BillingMedicaid: NumberInsertChange Request 050998856/21/2023 10:25 AM
Medicaid BillingMedicaid: StateInsertChange Request NY6/21/2023 10:25 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/21/2023 10:25 AM
Medicaid BillingMedicaid: NumberInsertChange Request 041335066/21/2023 10:25 AM
Medicaid BillingMedicaid: StateInsertChange Request NY6/21/2023 10:25 AM
Medicaid BillingNPI: NumberInsertChange Request 18710244556/21/2023 10:25 AM
Medicaid BillingNPI: StateInsertChange Request NY6/21/2023 10:25 AM
Medicaid BillingNPI: NumberInsertChange Request 11749264066/21/2023 10:25 AM
Medicaid BillingNPI: StateInsertChange Request NY6/21/2023 10:25 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request100446570A (KS) 5/10/2023 3:39 PM
Medicaid BillingMedicaid: NumberDeleteChange Request04133506 (NY) 4/4/2023 9:36 AM
Medicaid BillingNPI: NumberDeleteChange Request1871024455 (NY) 4/4/2023 9:36 AM
Medicaid BillingNPI: NumberDeleteChange Request1174926406 (NY) 4/4/2023 9:36 AM
DetailsLast Recertification DateUpdateRecertification9/9/2021 8:53:04 PM8/26/2022 12:49:48 PM8/26/2022 12:49 PM
DetailsLast Recertification DateUpdateRecertification9/8/2020 2:32:46 PM9/9/2021 8:53:04 PM9/9/2021 8:53 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/30/2021 9:57 AM
Medicaid BillingMedicaid: NumberInsertChange Request LON0195N3/30/2021 9:57 AM
Medicaid BillingMedicaid: StateInsertChange Request AL3/30/2021 9:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/30/2021 9:57 AM
Medicaid BillingMedicaid: NumberInsertChange Request 2397391053/30/2021 9:57 AM
Medicaid BillingMedicaid: StateInsertChange Request AR3/30/2021 9:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/30/2021 9:57 AM
Medicaid BillingMedicaid: NumberInsertChange Request 5982103/30/2021 9:57 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/30/2021 9:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/30/2021 9:57 AM
Medicaid BillingMedicaid: NumberInsertChange Request 12856415143/30/2021 9:57 AM
Medicaid BillingMedicaid: StateInsertChange Request CA3/30/2021 9:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/30/2021 9:57 AM
Medicaid BillingMedicaid: NumberInsertChange Request 90001822813/30/2021 9:57 AM
Medicaid BillingMedicaid: StateInsertChange Request CO3/30/2021 9:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/30/2021 9:57 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0031294013/30/2021 9:57 AM
Medicaid BillingMedicaid: StateInsertChange Request CT3/30/2021 9:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/30/2021 9:57 AM
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Medicaid BillingNPI: NumberInsertChange Request 18710244553/23/2021 4:06 PM
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Medicaid BillingNPI: NumberInsertRecertification 12856415149/8/2020 2:32 PM
Medicaid BillingNPI: StateInsertRecertification NY9/8/2020 2:32 PM
Medicaid BillingNPI: NumberDeleteRecertification1285641514 ( ) 9/8/2020 2:32 PM
DetailsLast Recertification DateUpdateRecertification9/9/2019 7:07:02 AM9/8/2020 2:32:46 PM9/8/2020 2:32 PM
DetailsLast Recertification DateUpdateRecertification9/5/2018 1:41:53 PM9/9/2019 7:07:02 AM9/9/2019 7:07 AM
DetailsLast Recertification DateUpdateRecertification12/1/2017 3:30:10 PM9/5/2018 1:41:53 PM9/5/2018 1:41 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestCusack, Michele L SVP & CFO Northwell Health 5168766061Cusack, Michele L SVP & CFO Northwell Health 51632160581/19/2018 2:42 PM
ContactsAuthorizing OfficialUpdateAO Change RequestShapiro, Robert S. EVP & CFO Northwell Health 5163216025Cusack, Michele L SVP & CFO Northwell Health 51687660611/9/2018 3:20 PM
ContactsAuthorizing OfficialUpdateAO Change RequestSHAPIRO, ROBERT S. SR. VP & CFO Northwell Health 5164658162Shapiro, Robert S. EVP & CFO Northwell Health 516321602512/4/2017 1:31 PM
DetailsLast Recertification DateUpdateRecertification8/31/2016 12:00:00 AM12/1/2017 3:30:10 PM12/1/2017 3:30 PM
ContactsAuthorizing OfficialUpdate SHAPIRO, ROBERT SR. VP & CFO 5164658162SHAPIRO, ROBERT S. SR. VP & CFO Northwell Health 516465816211/30/2017 11:47 AM
ContactsPrimary ContactUpdate Stefas, Onisis VP of Pharmacy Operations 5167195720Stefas, Onisis VP of Pharmacy Operations Northwell 516719572010/12/2017 1:11 PM
ContactsPrimary ContactUpdate Briscoe-Dwyer, Leigh A. Chief Pharmacy and Medication Safety Officer 5164723557Stefas, Onisis VP of Pharmacy Operations 51671957207/25/2017 12:32 PM
ContactsAuthorizing OfficialInsert  SHAPIRO, ROBERT SR. VP & CFO 51646581627/25/2017 12:32 PM
AddressesMain AddressInsert   270-05 76TH AVENUE NEW HYDE PARK, NY 110407/25/2017 12:31 PM
AddressesShipping AddressInsert  LONG ISLAND JEWISH MEDICAL CENTER 270-05 76TH AVE NEW HYDE PARK, NY 110407/25/2017 12:31 PM
AddressesShipping AddressInsert  ZUCKER HILLSIDE HOSPITAL 75-59 263RD ST GLEN OAKS, NY 110047/25/2017 12:31 PM
AddressesShipping AddressInsert  LONG ISLAND JEWISH VALLEY STREAM 900 FRANKLIN AVE VALLEY STREAM, NY 115807/25/2017 12:31 PM
AddressesShipping AddressInsert  LONG ISLAND JEWISH FOREST HILLS 102-01 66TH RD FOREST HILLS, NY 113757/25/2017 12:31 PM
AddressesShipping AddressInsert  MONTER CANCER CENTER 450 LAKEVILLE ROAD LAKE SUCCESS, NY 110427/25/2017 12:31 PM
AddressesShipping AddressInsert  Safecor Health 317 New Boston Street Woburn, MA 018017/25/2017 12:31 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False8/31/2016 3:00 PM
Medicaid BillingMedicaid: NumberInsert  029988878/31/2016 3:00 PM
Medicaid BillingMedicaid: StateInsert  NY8/31/2016 3:00 PM
DetailsLast Recertification DateUpdate 8/24/2015 12:00:00 AM8/31/2016 12:00:00 AM8/31/2016 3:00 PM
ContactsPrimary ContactUpdate ABBERTON, JAMES DIRECTOR OF PHARMACY SERVICES 7184707431Briscoe-Dwyer, Leigh A. Chief Pharmacy and Medication Safety Officer 51647235578/24/2015 4:38 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse8/24/2015 4:38 PM
DetailsLast Recertification DateUpdate 9/10/2014 12:00:00 AM8/24/2015 12:00:00 AM8/24/2015 4:38 PM
DetailsLast Recertification DateUpdate 9/6/2013 12:00:00 AM9/10/2014 12:00:00 AM9/10/2014 7:04 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/6/2013 12:00:00 AM9/6/2013 4:40 PM
Medicaid BillingNPI: NumberInsert  12856415145/29/2012 2:41 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/29/2012 2:41 PM
ContactsPrimary ContactInsert  ABBERTON, JAMES DIRECTOR OF PHARMACY SERVICES 71847074316/6/2007 1:24 PM
DetailsLast Recertification DateInsert   6/6/2007 1:24 PM
DetailsGrant NumberInsert   6/6/2007 1:24 PM
Details340B IDInsert  DSH3301956/6/2007 1:24 PM
DetailsIs Authorizing Official EHB DataInsert   6/6/2007 1:24 PM
DatesLast Date That 340B Drugs PurchasedInsert   6/6/2007 1:24 PM
DetailsMedicare Provider NumberInsert  3301956/6/2007 1:24 PM
DetailsEntity NameInsert  LONG ISLAND JEWISH MEDICAL CENTER6/6/2007 1:24 PM
DetailsProgram CodeInsert  DSH6/6/2007 1:24 PM
DetailsEntity SubnameInsert   6/6/2007 1:24 PM
DatesParticipating Approval DateInsert  6/6/2007 12:00:00 AM6/6/2007 1:24 PM
DetailsStateInsert  Active6/6/2007 1:24 PM
DatesRegistration DateInsert  6/5/2007 12:00:00 AM6/6/2007 1:24 PM
DatesSigned By DateInsert  5/16/2007 12:00:00 AM6/6/2007 1:24 PM
DatesStart DateInsert  7/1/2007 12:00:00 AM6/6/2007 1:24 PM
TerminationsTermination CommentsInsert   6/6/2007 1:24 PM
TerminationsTermination DateInsert   6/6/2007 1:24 PM
TerminationsTermination Effective DateInsert   6/6/2007 1:24 PM
TerminationsTermination ReasonInsert   6/6/2007 1:24 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True6/5/2007 4:18 PM
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