KATHLEEN FANELLI
NPI 1023833977
Nurse Practitioner - Acute Care in Port Jefferson, NY
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
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
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.
Medicare Billing Reassignment
Medicare enrollment records show Kathleen Fanelli reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Port Jefferson Station, NY 11777
- Reassigned Medicare billing, New York enrollment
- Also billed through NPI 1467249334 (New York)
- 232 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, NYPhysician 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.
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.
PORT JEFFERSON, NY 11777
PORT JEFFERSON, NY 11777
PORT JEFFERSON, NY 11777
PORT JEFFERSON, NY 11777
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.
Which organization bills Medicare for Kathleen Fanelli's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kathleen Fanelli reassigns Medicare benefits to John T. Mather Memorial Hospital (Port Jefferson Station, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kathleen Fanelli's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kathleen Fanelli · NPI 1023833977
Acute Care physician in Port Jefferson, New York. Individual provider, active in the CMS NPPES registry since November 16, 2024.
## Identity
- **NPI:** 1023833977 (Entity type: Individual)
- **Enumerated:** November 16, 2024
- **Primary specialty:** Nurse Practitioner - Acute Care · taxonomy 363LA2100X
- **State license:** F433058-01 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 75 N COUNTRY RD, Port Jefferson, NY 11777-2119
- **Phone:** (631) 473-1320
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** John T. Mather Memorial Hospital (NPI 1376642371, Port Jefferson Station, NY), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** March 20, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1023833977) · Data from the CMS NPPES public registry.