Individual provider Active NPI

Ganesh Ram, AGPCNP-BC

  • Adult Health Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1023524816
Registry record updated Dec 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F308409-1 Issued in NY
Practice address
374 Stockholm St
Brooklyn, NY 11237-4006
Phone
(718) 963-7272
NPI assigned
Dec 16, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F308409-1 NY Primary

Addresses

Primary practice location

374 Stockholm St
Brooklyn, NY 11237-4006

Mailing address

10733 129TH St
South Richmond Hill, NY 11419-3017
Phone (917) 327-2671

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
I20180411001133 NY Practitioner - Nurse Practitioner 1254694961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wyckoff Professional Medical Services PCGroup PAC ID 6406748607, 154 clinicians

Practice addresses (Care Compare)

7554 Metropolitan Ave
Middle Village, NY 11379-2639
Phone (718) 894-4200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
308409NYMDLicensed Practical Nurse
F308409-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wyckoff Professional Medical Services, PC CurrentSince Feb 14, 2018 Accepting new patients

Locations

374 Stockholm St
#13202
Brooklyn, NY 11237
Phone (718) 963-6793

374 Stockholm St
Brooklyn, NY 11237
Phone (718) 963-6485

1419 Myrtle Ave
Brooklyn, NY 11237
Phone (718) 455-4909

7554 Metropolitan Ave
Middle Vlg, NY 11379
Phone (718) 326-0400

7554 Metropolitan Ave
#13292
Middle Vlg, NY 11379

Networks

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

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1513382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513382400000",
    "number": "1023524816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10733 129TH ST",
            "city": "SOUTH RICHMOND HILL",
            "state": "NY",
            "postal_code": "114193017",
            "telephone_number": "917-327-2671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 STOCKHOLM ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374006",
            "telephone_number": "718-963-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAM",
        "first_name": "GANESH",
        "name_prefix": "Mr.",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-16",
        "last_updated": "2017-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F308409-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.