MS. MARYELLEN BLANK NP
NPI 1609930015
Nurse Practitioner - Psychiatric/Mental Health in Bay Shore, NY

Q: What is Maryellen Blank's NPI number?

The NPI number for Maryellen Blank is 1609930015. It was assigned to this individual provider in the NPPES registry on December 20, 2006.

Q: What is Maryellen Blank's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Maryellen Blank was last updated on October 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since December 20, 2006PECOS EnrolledAccepts Medicare Assignment

21 4TH AVE, BAY SHORE, NY 11706(631) 665-6707(631) 665-3564 Get Directions Write a Review

NPPES record last updated: October 17, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Ms. Maryellen Blank Np NPPES

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

MS. MARYELLEN BLANK NP (NPI 1609930015) is an individual psychiatric/mental health provider in Bay Shore, New York, licensed in New York (F400620-01) and active in the NPI registry since December 2006. She is enrolled in Medicare PECOS and is a graduate of Other (1991).

NPPES Registry Identity

NPI1609930015

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameMS. MARYELLEN BLANKCredential: NP

Location Address21 4TH AVEBay Shore, NY 11706-7908

Mailing Address170 Driftwood DrWest Islip, NY 11795-5002 · (631) 422-7362

Phone(631) 665-6707

Fax(631) 665-3564

Sole ProprietorYes

Medical School CMSOtherGraduated 1991

Enumeration DateDecember 20, 2006

Last NPPES UpdateOctober 17, 2024

NPPES CertifiedOctober 17, 2024

✔ NPI 1609930015 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in NY · F400620-01

Also ListedClinical Nurse Specialist · Psychiatric/Mental Health, AdultTaxonomy 364SP0809X · License 400620 (NY)

21 4TH AVE, Bay Shore, NY 11706

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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 and accepts Medicare assignment

Ms. Maryellen Blank Np 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 ID1759609688

PECOS Enrollment IDI20150406000602

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 Reassignments

Medicare enrollment records show Maryellen Blank reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Catholic Charities Of The Diocese Of Rockville Centre

0.2 mi

Mental Health (Including Community Mental Health Center)

9 4TH AVE
Bay Shore, NY 11706

Reassigned Medicare billing, New York enrollment
27 clinicians in this Medicare group

NPI 1124034558 (631) 665-6707

The Long Island Home

9.5 mi

Psychiatric Hospital

400 SUNRISE HWY
Amityville, NY 11701

Reassigned Medicare billing, New York enrollment
123 clinicians in this Medicare group

NPI 1568459204 (631) 264-4000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

245 services80 patients

Psychiatric diagnostic evaluation with medical services 90792

A psychiatric diagnostic evaluation with medical services is a comprehensive assessment. It includes a detailed examination of your mental health and physical wellbeing, as well as your personal and family history. This evaluation aids in creating an effective treatment plan.

14 services14 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11706 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 13

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

DANIELLA PETRINI MSW

Social Worker