DR. MANUEL LICITRA FAJARDO M.D.
NPI 1831461417
Internal Medicine in Garden City, NY
About Dr. Manuel Licitra Fajardo M.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. MANUEL LICITRA FAJARDO M.D. (NPI 1831461417) is an individual internal medicine provider in Garden City, New York, licensed in New York (279410) and active in the NPI registry since January 2012. He is enrolled in Medicare PECOS, is affiliated with Mount Sinai South Nassau, and is a graduate of Other (2011).
NPPES Registry Identity
Specialties & Licenses 2
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
Dr. Manuel Licitra Fajardo M.d. 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.
Medicare Billing Reassignments
6Medicare enrollment records show Manuel Fajardo reassigns Medicare billing to 6 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Hempstead, NY 11550
- Reassigned Medicare billing, New York enrollment
- 302 clinicians in this Medicare group
New Hyde Park, NY 11040
- Reassigned Medicare billing, New York enrollment
- 9,353 clinicians in this Medicare group
Far Rockaway, NY 11691
- Reassigned Medicare billing, New York enrollment
- 60 clinicians in this Medicare group
Bronxville, NY 10708
- Reassigned Medicare billing, New York enrollment
- 531 clinicians in this Medicare group
Port Jefferson, NY 11777
- Reassigned Medicare billing, New York enrollment
- Medicare enrollment name: Port Emergency Medical Services PC
- 90 clinicians in this Medicare group
Binghamton, NY 13905
- Reassigned Medicare billing, New York enrollment
- 528 clinicians in this Medicare group
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 3
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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Mount Sinai South Nassau
Acute Care Hospitals · Oceanside, NYPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 11530 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
Referred Medical Equipment & Supplies CMS DME claims 5
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
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 Manuel Fajardo's NPI number?
The NPI number for Manuel Fajardo is 1831461417. It was assigned to this individual provider in the NPPES registry on January 30, 2012.
Where is Manuel Fajardo located?
Manuel Fajardo practices at 100 Somerset Ave Garden City, Garden City, NY 11530. The listed phone number is (516) 741-4898.
What is Manuel Fajardo's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Manuel Fajardo enrolled in Medicare?
Yes. Manuel Fajardo 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.
Which organizations bill Medicare for Manuel Fajardo's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Manuel Fajardo reassigns Medicare benefits to 6 organizations: Mount Sinai School Of Medicine (Hempstead, NY), North Shore - Lij Medical PC (New Hyde Park, NY), 24 On Physicians, PC (Far Rockaway, NY), Lawrence Medical Associates, PC (Bronxville, NY), Port Emergency Medical Services, P.C. (Port Jefferson, NY) and 1 more organization, listed in the Medicare section above. Each 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 Manuel Fajardo's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Manuel Fajardo affiliated with any hospitals?
According to CMS data, Manuel Fajardo is affiliated with Mount Sinai South Nassau.
When was this NPI record last updated?
The NPPES record for Manuel Fajardo was last updated on January 23, 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.
# Dr. Manuel Licitra Fajardo, M.D. · NPI 1831461417
Internal Medicine physician in Garden City, New York. Individual provider, active in the CMS NPPES registry since January 30, 2012.
## Identity
- **NPI:** 1831461417 (Entity type: Individual)
- **Enumerated:** January 30, 2012
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **State license:** 279410 (New York)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 100 SOMERSET AVE, GARDEN CITY, Garden City, NY 11530-1231
- **Phone:** (516) 741-4898
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 6 organizations under Medicare reassignment (form CMS-855R): Mount Sinai School Of Medicine (NPI 1508333956, Hempstead, NY); North Shore - Lij Medical PC (NPI 1790043479, New Hyde Park, NY); 24 On Physicians, PC (NPI 1578781787, Far Rockaway, NY); Lawrence Medical Associates, PC (NPI 1497260806, Bronxville, NY); Port Emergency Medical Services, P.C. (NPI 1912988395, Port Jefferson, NY); and 1 more · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2011
## Record status
- **NPPES last updated:** January 23, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1831461417) · Data from the CMS NPPES public registry.