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SU JI KWON PA-C
NPI 1811666290
Physician Assistant in Mineola, NY

Active since September 09, 2021PECOS EnrolledAccepts Medicare Assignment
84.47/100
CMS Quality Rating

NPPES record last updated: February 18, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 18, 2023, Aug 22, 2022, Sep 9, 2021 (3 updates tracked since 2021).

About Su Ji Kwon Pa-c NPPES

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

SU JI KWON PA-C (NPI 1811666290) is an individual physician assistant in Mineola, New York and active in the NPI registry since September 2021. She is enrolled in Medicare PECOS, is affiliated with Nyu Langone Hospitals, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1811666290
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameSU JI KWONCredential: PA-C
Location Address259 1ST STMineola, NY 11501-3957
Mailing Address259 1st StMineola, NY 11501-3957 · (516) 663-8312
Phone(516) 663-8312
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateSeptember 9, 2021
Last NPPES UpdateFebruary 18, 20233 updates tracked since enumeration
NPPES CertifiedFebruary 18, 2023
✔ NPI 1811666290 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
259 1ST ST, 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

Su Ji Kwon Pa-c 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 ID3173911831
PECOS Enrollment IDI20211028002791
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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Nyu Langone Hospitals

Acute Care Hospitals · New York, NY
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330214
Location550 First AvenueNew York, NY 10016 · New York County
Emergency services Birthing friendly

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
$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
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
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 20

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

LINDSY MILLER M.D.
Anesthesiology
259 1ST ST
MINEOLA, NY 11501
Nassau County (516) 741-0570
GINA CARUCCI
Physician Assistant (Medical)
259 1ST ST
MINEOLA, NY 11501
Nassau County (516) 663-0333
DR. CHRISTIAN GIGANTE MD
Student in an Organized Health Care Education/Training Program
259 1ST ST
MINEOLA, NY 11501
Nassau County (516) 663-8794
CHRISTOPHER PETILLO
Student in an Organized Health Care Education/Training Program
259 1ST ST
MINEOLA, NY 11501
Nassau County (516) 663-0333
JOHN ANTHONY DINELLI MD
Student in an Organized Health Care Education/Training Program
259 1ST ST
MINEOLA, NY 11501
Nassau County (516) 663-0333
MANISHA SAKORE MD
Pediatrics (Neonatal-Perinatal Medicine)
259 1ST ST
MINEOLA, NY 11501
Nassau County (516) 663-3853
DR. LAWRENCE SCHEINBERG M.D.
Anesthesiology
259 1ST ST
MINEOLA, NY 11501
Nassau County (516) 663-0333
DR. KIM ANN RUTHERFORD M.D.
Pediatrics (Pediatric Emergency Medicine)
259 1ST ST
MINEOLA, NY 11501
Nassau County (717) 531-8955

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 Su Ji Kwon's NPI number?

The NPI number for Su Ji Kwon is 1811666290. It was assigned to this individual provider in the NPPES registry on September 9, 2021.

Where is Su Ji Kwon located?

Su Ji Kwon practices at 259 1st St, Mineola, NY 11501. The listed phone number is (516) 663-8312.

What is Su Ji Kwon's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Su Ji Kwon enrolled in Medicare?

Yes. Su Ji Kwon 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.

Is Su Ji Kwon affiliated with any hospitals?

According to CMS data, Su Ji Kwon is affiliated with Nyu Langone Hospitals.

When was this NPI record last updated?

The NPPES record for Su Ji Kwon was last updated on February 18, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.