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JACQUELINE FORMAN
NPI 1780020560
Internal Medicine - Gastroenterology in Mineola, NY

Active since May 20, 2013PECOS EnrolledAccepts Medicare Assignment
84.47/100
CMS Quality Rating
222 STATION PLZ N STE 428, MINEOLA, NY 11501(516) 663-2066 Get Directions Write a Review

NPPES record last updated: March 31, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 31, 2021, Jul 16, 2020 (2 updates tracked since 2020).

About Jacqueline Forman NPPES

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

JACQUELINE FORMAN (NPI 1780020560) is an individual gastroenterology provider in Mineola, New York, licensed in New York (287977) and active in the NPI registry since May 2013. She is enrolled in Medicare PECOS and is a graduate of State University Of New York Downstate Medical Center (2013).

NPPES Registry Identity

NPI1780020560
Entity TypeIndividualFemale
Primary Taxonomy207RG0100X
Provider Legal NameJACQUELINE FORMAN
Location Address222 STATION PLZ N STE 428Mineola, NY 11501-3819
Mailing Address222 Station Plz N Ste 428Mineola, NY 11501-3819 · (516) 663-2066
Phone(516) 663-2066
Sole ProprietorYes
Medical School CMSState University Of New York Downstate Medical CenterGraduated 2013
Enumeration DateMay 20, 2013
Last NPPES UpdateMarch 31, 20212 updates tracked since enumeration
NPPES CertifiedMarch 31, 2021
✔ NPI 1780020560 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code207RG0100X
License✔ Licensed in NY · 287977
Definition
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
222 STATION PLZ N STE 428, Mineola, NY 11501
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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 Forman 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 ID7719301480
PECOS Enrollment IDI20200728002332
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.

Areas of Expertise CMS Part B claims 9

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
127 services73 patients
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.
63 services53 patients
Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221
Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.
52 services50 patients
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
33 services32 patients
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239
This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.
28 services28 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
25 services25 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11501 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
$154.28 typical visit price
range $67.40 – $203.53
Typical copayment $38.57 (range $16.85 – $50.88)
Most-billed visit code 99204
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

84.47/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality93.33
Promoting Interoperability100
Improvement Activities40
Cost54.91

Other Providers at the Same Location NPPES 3

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

IOSIF GALIBOV RPA-C
Physician Assistant
222 STATION PLZ N STE 428
MINEOLA, NY 11501
Nassau County (516) 663-3852
MELISSA PERSAUD
Physician Assistant
222 STATION PLZ N STE 428
MINEOLA, NY 11501
Nassau County (516) 663-2066
LAURA O'CONNOR RDN, CDN, CNSC
Dietitian, Registered
222 STATION PLZ N STE 428
MINEOLA, NY 11501
Nassau County (516) 663-4808

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 Forman's NPI number?

The NPI number for Jacqueline Forman is 1780020560. It was assigned to this individual provider in the NPPES registry on May 20, 2013.

Where is Jacqueline Forman located?

Jacqueline Forman practices at 222 Station Plz N Ste 428, Mineola, NY 11501. The listed phone number is (516) 663-2066.

What is Jacqueline Forman's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Is Jacqueline Forman enrolled in Medicare?

Yes. Jacqueline Forman 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.

When was this NPI record last updated?

The NPPES record for Jacqueline Forman was last updated on March 31, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.