MS. IDALISSIE ALTAGRACIA PEGUERO APN, PMHNPBC
NPI 1689154437
Nurse Practitioner - Psychiatric/Mental Health in Newark, NJ

Q: What is Idalissie Peguero's NPI number?

The NPI number for Idalissie Peguero is 1689154437. It was assigned to this individual provider in the NPPES registry on August 20, 2018.

Q: What is Idalissie Peguero'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 Idalissie Peguero was last updated on October 10, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since August 20, 2018PECOS EnrolledAccepts Medicare Assignment

550 BROAD ST STE 606, NEWARK, NJ 07102(201) 822-1161(877) 485-8918 Get Directions Write a Review

NPPES record last updated: October 10, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Oct 10, 2024, Nov 20, 2023, Aug 20, 2018 (3 updates tracked since 2018).

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About Ms. Idalissie Altagracia Peguero Apn, Pmhnpbc NPPES

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

MS. IDALISSIE ALTAGRACIA PEGUERO APN, PMHNPBC (NPI 1689154437) is an individual psychiatric/mental health provider in Newark, New Jersey, licensed in New Jersey (26NJ00838200) and active in the NPI registry since August 2018. She is enrolled in Medicare PECOS, maintains a secondary practice location in Paterson, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1689154437

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameMS. IDALISSIE ALTAGRACIA PEGUEROCredential: APN, PMHNPBC

Location Address550 BROAD ST STE 606Newark, NJ 07102-4537

Mailing Address606 BroadwayPaterson, NJ 07514-1916 · (973) 523-4000

Phone(201) 822-1161

Fax(877) 485-8918

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateAugust 20, 2018

Last NPPES UpdateOctober 10, 20243 updates tracked since enumeration

NPPES CertifiedOctober 10, 2024

✔ NPI 1689154437 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 NJ · 26NJ00838200

Also ListedNurse PractitionerTaxonomy 363L00000X · License 26NJ00838200 (NJ)

550 BROAD ST STE 606, Newark, NJ 07102

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Secondary Practice Location 1

Location 1606 BroadwayPaterson, NJ 07514-1916 · Phone (973) 523-4000

Other Identifiers 1

Medicaid0655881NJ

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

Ms. Idalissie Altagracia Peguero Apn, Pmhnpbc 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 ID8527311489

PECOS Enrollment IDI20181024000014

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07102 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

$98.09 typical visit price

range $63.84 – $190.92

Typical copayment $24.52 (range $15.96 – $47.73)

Most-billed visit code 99203

Established Patient

$111.57 typical visit price

range $20.97 – $155.92

Typical copayment $27.89 (range $5.24 – $38.98)

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.

JLS MEDICAL PC

Psychiatry & Neurology (Psychiatry)