NPIMap

Individual provider Active NPI

Berhane Wubshet, M.D.

  • Internal Medicine Physician
  • Jamaica, NY
National Provider Identifier
1013963297
Registry record updated Mar 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
195697 Issued in NY
Practice address
9131 175TH St
Jamaica, NY 11432-5517
Phone
(718) 657-6363
NPI assigned
May 26, 2006
Last updated
Mar 12, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 195697 NY Primary

Addresses

Primary practice location

9131 175TH St
Jamaica, NY 11432-5517

Mailing address

3054 Ann St
Baldwin, NY 11510-4501
Phone (718) 272-0977

Other identifiers 1

IdentifierTypeStateIssuer
01669130MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060721000048 NY Practitioner - Internal Medicine 1850304643 Reassigns benefits to 2 organizations
Practice locations: Baldwin, NY; Brooklyn, NY; Jamaica, NY

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blue Nile Medical PLLCGroup PAC ID 6204196462, 2 clinicians

Practice addresses (Care Compare)

585 Schenectady Ave
Brooklyn, NY 11203-1822
Phone (718) 604-5000

9408 Flatlands Ave
Brooklyn, NY 11236-3742
Phone (718) 272-0977

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
CMC Radiological Services PC Past Accepting new patients
Rutland Nursing Home Inc Past Accepting new patients
CMC Radiological Services PC Past Accepting new patients

Networks

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

Organizations & group practices 5

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

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": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331510400000",
    "number": "1013963297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3054 ANN ST",
            "city": "BALDWIN",
            "state": "NY",
            "postal_code": "115104501",
            "telephone_number": "718-272-0977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9131 175TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114325517",
            "telephone_number": "718-657-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WUBSHET",
        "first_name": "BERHANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2012-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "195697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01669130",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.