1. Home
  2. Directory
  3. New York
  4. Lake Grove
  5. Physician Assistant
  6. NPI Profile

JACQUELINE SOMMER COLALILLO
NPI 1104701671
Physician Assistant in Lake Grove, NY

Active since August 06, 2025PECOS EnrolledAccepts Medicare Assignment
4 SMITH HAVEN MALL STE 110, LAKE GROVE, NY 11755(631) 444-6270 Get Directions Write a Review

NPPES record last updated: August 25, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jacqueline Sommer Colalillo NPPES

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

JACQUELINE SOMMER COLALILLO (NPI 1104701671) is an individual physician assistant in Lake Grove, New York and active in the NPI registry since August 2025. She is enrolled in Medicare PECOS, is affiliated with Suny/stony Brook University Hospital, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1104701671
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameJACQUELINE SOMMER COLALILLO
Location Address4 SMITH HAVEN MALL STE 110Lake Grove, NY 11755-1219
Mailing Address4 Smith Haven Mall Ste 110Lake Grove, NY 11755-1219
Phone(631) 444-6270
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateAugust 6, 2025
Last NPPES UpdateAugust 25, 2025
NPPES CertifiedAugust 25, 2025
✔ NPI 1104701671 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
4 SMITH HAVEN MALL STE 110, Lake Grove, NY 11755
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

Jacqueline Sommer Colalillo 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 ID2264929777
PECOS Enrollment IDI20251016003295
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.

Suny/Stony Brook University Hospital

Acute Care Hospitals · Stony Brook, NY
4/5 CMS rating
OwnershipGovernment - State
CMS Certification Number330393
LocationHealth Sciences Center SunyStony Brook, NY 11794 · Suffolk County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11755 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
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
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

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

KRISTEN TOOMA MSN, APRN, AGNCNP-BC
Nurse Practitioner (Adult Health)
4 SMITH HAVEN MALL STE 110
LAKE GROVE, NY 11755
Suffolk County (631) 444-6270

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 Jacqueline Colalillo's NPI number?

The NPI number for Jacqueline Colalillo is 1104701671. It was assigned to this individual provider in the NPPES registry on August 6, 2025.

Where is Jacqueline Colalillo located?

Jacqueline Colalillo practices at 4 Smith Haven Mall Ste 110, Lake Grove, NY 11755. The listed phone number is (631) 444-6270.

What is Jacqueline Colalillo's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Jacqueline Colalillo enrolled in Medicare?

Yes. Jacqueline Colalillo 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 Jacqueline Colalillo affiliated with any hospitals?

According to CMS data, Jacqueline Colalillo is affiliated with Suny/Stony Brook University Hospital.

When was this NPI record last updated?

The NPPES record for Jacqueline Colalillo was last updated on August 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.