Individual provider Active NPI

Grace Blair Condori, PA

  • Medical Physician Assistant
  • Fresh Meadows, NY
National Provider Identifier
1013637297
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
17505 Horace Harding Expy
Fresh Meadows, NY 11365-1535
Phone
(718) 990-8417
NPI assigned
Aug 30, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NY Primary

Addresses

Primary practice location

17505 Horace Harding Expy
Fresh Meadows, NY 11365-1535

Mailing address

6 Woodland Ave
Port Chester, NY 10573-2947
Phone (914) 934-1442

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241016003582 NY Practitioner - Physician Assistant 9234661117 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Post Road Medical Services PCGroup PAC ID 6406198506, 419 clinicians

Practice addresses (Care Compare)

41 E Post Rd
White Plains, NY 10601-4607
Phone (914) 681-0600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
White Plains Physician Services PC CurrentSince Sep 11, 2024 Accepting new patients

Locations

185 Kisco Ave
Ste 300
Mount Kisco, NY 10549
Phone (914) 242-2020

122 Maple Ave
Fl 9
White Plains, NY 10601
Phone (914) 849-3755

41 E Post Rd
White Plains, NY 10601
Phone (914) 681-1201

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1013637297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 WOODLAND AVE",
            "city": "PORT CHESTER",
            "state": "NY",
            "postal_code": "105732947",
            "telephone_number": "914-934-1442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17505 HORACE HARDING EXPY",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113651535",
            "telephone_number": "718-990-8417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDORI",
        "first_name": "GRACE",
        "middle_name": "BLAIR",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-30",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresh Meadows, NY

Sources for this page

Verify at the official NPI Registry.