NPIMap

Organization Active NPI

Ra Psychiatric NP Services PLLC

Doing business as SouthEnd Psychiatry

  • Psychiatry Physician
  • Bronx, NY
National Provider Identifier
1023626678
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
RA PSYCHIATRIC NP SERVICES PLLC
Doing business as
SouthEnd Psychiatry
Practice address
2722 Hering Ave
Bronx, NY 10469-5321
Phone
(917) 557-6064
NPI assigned
Jul 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Authorized official

Name
Reagan Anusionwu, NPPNPI 1346492105
Title
Ceo
Phone
(917) 557-6064

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

2722 Hering Ave
Bronx, NY 10469-5321

Mailing address

2722 Hering Ave
Bronx, NY 10469-5321
Phone (917) 557-6064

Other names 1

  • SouthEnd Psychiatry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210521002361 NY Part B Supplier - Clinic/Group Practice 4880093905 Receives reassigned benefits from 11 practitioners
Practice locations: Bronx, NY
O20240118001182 NJ Part B Supplier - Clinic/Group Practice 4880093905 Receives reassigned benefits from 4 practitioners
Practice locations: Newark, NJ

National Provider Directory

National Provider Directory

Locations

89 Market St
Ste 2M
Newark, NJ 07102
Phone (800) 632-7969

89 Market St
Ste 2
Newark, NJ 07102
Phone (800) 632-7969

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1023626678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2722 HERING AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104695321",
            "telephone_number": "917-557-6064",
            "fax_number": "917-591-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2722 HERING AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104695321",
            "telephone_number": "917-557-6064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RA PSYCHIATRIC NP SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-20",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A",
        "authorized_official_last_name": "ANUSIONWU",
        "authorized_official_first_name": "REAGAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "917-557-6064",
        "authorized_official_credential": "NPP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SouthEnd Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.