Individual provider Active NPI

Mychal Shira Grodstein, RPA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1043512585
Registry record updated Dec 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014435-01 Issued in NY
Practice address
525 E 68TH St
M130
New York, NY 10065-4870
Phone
(212) 746-0780
NPI assigned
Dec 2, 2010
Last updated
Dec 2, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 014435-01 NY Primary

Addresses

Primary practice location

525 E 68TH St
M130
New York, NY 10065-4870

Mailing address

344 3Rd Ave Apt 2G
New York, NY 10010-2324
Phone (401) 683-8036

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
I20110531000609 NY Practitioner - Physician Assistant 1658558697 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

300 Community Dr
Manhasset, NY 11030-3816

300 Community Dr LL
Manhasset, NY 11030-3816
Phone (516) 562-2229

330 Community Dr
Manhasset, NY 11030-3816
Phone (516) 708-2550

350 Community Dr
Manhasset, NY 11030-3816
Phone (516) 562-3845

865 Northern Blvd
Great Neck, NY 11021-5310
Phone (516) 622-5070

865 Northern Blvd
Great Neck, NY 11021-5335

865 Northern Boulevard
Great Neck, NY 11021-5310

865 Northern Boulevard
3Rd Floor
Great Neck, NY 11021-5335
Phone (516) 708-2550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
014435NYMDOccupational Therapist
014435-01NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Nov 20, 2017 Accepting new patients
Weill Medical College of Cornell CurrentSince Nov 20, 2017 Accepting new patients
Weill Medical College of Cornell CurrentSince Nov 20, 2017 Accepting new patients
Weill Medical College of Cornell Past Accepting new patients

Locations

300 Community Dr
Manhasset, NY 11030

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

525 E 68th St
#M130
New York, NY 10065
Phone (212) 746-0780

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • Direct secure messaging: mychalgrodstein@nslijmedgr.allscriptsdirect.net

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 1

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": "1291248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291248000000",
    "number": "1043512585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 3RD AVE APT 2G",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100102324",
            "telephone_number": "401-683-8036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST",
            "address_2": "M130",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654870",
            "telephone_number": "212-746-0780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRODSTEIN",
        "first_name": "MYCHAL",
        "middle_name": "SHIRA",
        "name_prefix": "Mrs.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-02",
        "last_updated": "2010-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014435-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.