QUEENS VILLAGE PRIMARY MEDICAL CARE, PLLC
NPI 1164614590
Clinic/Center - Primary Care in Queens Village, NY
About Queens Village Primary Medical Care, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
QUEENS VILLAGE PRIMARY MEDICAL CARE, PLLC (NPI 1164614590) is a healthcare organization registered as a primary care in Queens Village, New York and active in the NPI registry since August 2007. The organization lists Aryel Nicoleau, Medical Doctor, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Queens Village Primary Medical Care, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Queens Village Primary Medical Care, PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Queens Village, NY 11428
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Queens Village Primary Medical Care, PLLC's NPI number?
The NPI number for Queens Village Primary Medical Care, PLLC is 1164614590. It was assigned to this organization in the NPPES registry on August 9, 2007.
Where is Queens Village Primary Medical Care, PLLC located?
Queens Village Primary Medical Care, PLLC is located at 9204 Springfield Blvd, Queens Village, NY 11428. The listed phone number is (718) 465-3040.
What is Queens Village Primary Medical Care, PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Queens Village Primary Medical Care, PLLC enrolled in Medicare?
Yes. Queens Village Primary Medical Care, PLLC is registered in the Medicare PECOS enrollment system.
When is Queens Village Primary Medical Care, PLLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New York, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Queens Village Primary Medical Care, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Queens Village Primary Medical Care, PLLC, in Internal Medicine and Nurse Practitioner. A 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 the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Queens Village Primary Medical Care, PLLC was last updated on February 1, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years 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.
# Queens Village Primary Medical Care, Pllc · NPI 1164614590
Primary Care organization in Queens Village, New York. Organization record, active in the CMS NPPES registry since August 9, 2007.
## Identity
- **NPI:** 1164614590 (Entity type: Organization)
- **Enumerated:** August 9, 2007
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Aryel Nicoleau, MEDICAL DOCTOR
## Practice location
- **Address:** 9204 SPRINGFIELD BLVD, Queens Village, NY 11428-1857
- **Phone:** (718) 465-3040 · **Fax:** (718) 464-9063
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, New York, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (1), Nurse Practitioner (1); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 1, 2017
- **Other identifiers:** Medicare PIN 06974 (NY); Medicaid 00587146 (NY)
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Source: [NPI Profile](https://npiprofile.com/npi/1164614590) · Data from the CMS NPPES public registry.