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NICOLE ANN BLUETHGEN FNP, RN
NPI 1104701911
Nurse Practitioner - Family in Stony Brook, NY

Active since August 11, 2025PECOS Enrolled
101 NICOLLS RD, STONY BROOK, NY 11794(631) 689-8333 Get Directions Write a Review

NPPES record last updated: August 11, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Nicole Ann Bluethgen Fnp, Rn NPPES

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

NICOLE ANN BLUETHGEN FNP, RN (NPI 1104701911) is an individual family provider in Stony Brook, New York, licensed in New York (357425) 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

NPI1104701911
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameNICOLE ANN BLUETHGENCredential: FNP, RN
Location Address101 NICOLLS RDStony Brook, NY 11794-0001
Mailing Address1 Mohannis WayKings Park, NY 11754-4547
Phone(631) 689-8333
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateAugust 11, 2025
NPPES CertifiedAugust 10, 2025
✔ NPI 1104701911 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in NY · 357425
101 NICOLLS RD, Stony Brook, NY 11794
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicole Ann Bluethgen Fnp, Rn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID345730883
PECOS Enrollment IDI20251104002798
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.

Medicare Billing Reassignment

Medicare enrollment records show Nicole Bluethgen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Stony Brook Internists, University Faculty Practice Corporation
0.5 mi
Pulmonary Disease
SUNY @ STONY BROOK, HSC, L16, RM 020
Stony Brook, NY 11794
  • Reassigned Medicare billing, New York enrollment
  • 177 clinicians in this Medicare group
NPI 1104865229 (631) 444-2448

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.

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 11794 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.

NARINDER SINGH M.D.
Internal Medicine
101 NICOLLS RD
STONY BROOK, NY 11794
Suffolk County (631) 444-4000
DR. KANHAI FARRAKHAN MD
Internal Medicine (Gastroenterology)
101 NICOLLS RD
STONY BROOK, NY 11794
Suffolk County (631) 444-0580
MS. HAYLEY ALEXANDRA MENA LMSW
Social Worker (Clinical)
101 NICOLLS RD
STONY BROOK, NY 11794
Suffolk County (516) 761-4107
MRS. HEATHER MARIE CALIGIURI ANP
Nurse Practitioner (Adult Health)
101 NICOLLS RD
STONY BROOK, NY 11794
Suffolk County (631) 631-4449
MR. SAM TARIK MENDOUNE I NP
Nurse Practitioner (Adult Health)
101 NICOLLS RD
STONY BROOK, NY 11794
Suffolk County (631) 335-1657
ALEXIE LESSING
Student in an Organized Health Care Education/Training Program
101 NICOLLS RD
STONY BROOK, NY 11794
Suffolk County (631) 444-4686
DR. BENJAMIN RISMANY MD
Student in an Organized Health Care Education/Training Program
101 NICOLLS RD
STONY BROOK, NY 11794
Suffolk County (631) 444-1791
JULIA RYAN MD
Student in an Organized Health Care Education/Training Program
101 NICOLLS RD
STONY BROOK, NY 11794
Suffolk County (631) 689-8333

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 Nicole Bluethgen's NPI number?

The NPI number for Nicole Bluethgen is 1104701911. It was assigned to this individual provider in the NPPES registry on August 11, 2025.

Where is Nicole Bluethgen located?

Nicole Bluethgen practices at 101 Nicolls Rd, Stony Brook, NY 11794. The listed phone number is (631) 689-8333.

What is Nicole Bluethgen's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Nicole Bluethgen enrolled in Medicare?

Yes. Nicole Bluethgen is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Nicole Bluethgen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicole Bluethgen reassigns Medicare benefits to Stony Brook Internists, University Faculty Practice Corporation (Stony Brook, 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 Nicole Bluethgen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Nicole Bluethgen affiliated with any hospitals?

According to CMS data, Nicole Bluethgen is affiliated with Suny/Stony Brook University Hospital.

When was this NPI record last updated?

The NPPES record for Nicole Bluethgen was last updated on August 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.