1. Home
  2. Directory
  3. New York
  4. Port Jefferson
  5. Nurse Practitioner
  6. NPI Profile

KATHLEEN FANELLI
NPI 1023833977
Nurse Practitioner - Acute Care in Port Jefferson, NY

Active since November 16, 2024PECOS EnrolledAccepts Medicare Assignment
75 N COUNTRY RD, PORT JEFFERSON, NY 11777(631) 473-1320 Get Directions Write a Review

NPPES record last updated: March 20, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 20, 2025, Nov 16, 2024 (2 updates tracked since 2024).

About Kathleen Fanelli NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATHLEEN FANELLI (NPI 1023833977) is an individual acute care provider in Port Jefferson, New York, licensed in New York (F433058-01) and active in the NPI registry since November 2024. She is enrolled in Medicare PECOS, is affiliated with John T Mather Memorial Hospital Of Port Jefferson, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1023833977
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameKATHLEEN FANELLI
Location Address75 N COUNTRY RDPort Jefferson, NY 11777-2119
Mailing Address77 Pacific AveDeer Park, NY 11729-3141 · (516) 317-4169
Phone(631) 473-1320
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateNovember 16, 2024
Last NPPES UpdateMarch 20, 20252 updates tracked since enumeration
NPPES CertifiedMarch 20, 2025
✔ NPI 1023833977 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in NY · F433058-01
75 N COUNTRY RD, Port Jefferson, NY 11777
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kathleen Fanelli is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7012431638
PECOS Enrollment IDI20250404001335
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

John T Mather Memorial Hospital Of Port Jefferson

Acute Care Hospitals · Port Jefferson, NY
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330185
Location75 North Country RoadPort Jefferson, NY 11777 · Suffolk County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11777 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$117.62 typical visit price
range $21.66 – $164.45
Typical copayment $29.40 (range $5.41 – $41.11)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUSTINA CATHERINE MELLONE DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
AAKAASH VARMA MD
Dermatology
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
KRISELA VOJNIKU MD
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549
LORETTA DIDWELL
Physician Assistant
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 473-1320
RAYMOND WONG
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-7654
KATLYN ANN CONVILLE ANTHONY NP
Nurse Practitioner (Family)
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2565
SHEHNAZ WASIM MD
Internal Medicine
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-1443
JULIA KOROBENKO DO
Student in an Organized Health Care Education/Training Program
75 N COUNTRY RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 686-2549

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kathleen Fanelli's NPI number?

The NPI number for Kathleen Fanelli is 1023833977. It was assigned to this individual provider in the NPPES registry on November 16, 2024.

Where is Kathleen Fanelli located?

Kathleen Fanelli practices at 75 N Country Rd, Port Jefferson, NY 11777. The listed phone number is (631) 473-1320.

What is Kathleen Fanelli's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Kathleen Fanelli enrolled in Medicare?

Yes. Kathleen Fanelli is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Kathleen Fanelli affiliated with any hospitals?

According to CMS data, Kathleen Fanelli is affiliated with John T Mather Memorial Hospital Of Port Jefferson.

When was this NPI record last updated?

The NPPES record for Kathleen Fanelli was last updated on March 20, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.