Individual provider Active NPI

Cecil A Dollison

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1043530769
Registry record updated Sep 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
006648 Issued in NY
Practice address
1349 Broadway
Brooklyn, NY 11221-3618
Phone
(718) 975-2270
Fax
(718) 975-2271
NPI assigned
Jun 3, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2014

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 006648 NY Primary

Addresses

Primary practice location

1349 Broadway
Brooklyn, NY 11221-3618

Mailing address

1349 Broadway
Brooklyn, NY 11221-3618
Phone (718) 975-2270

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
I20110413000479 NY Practitioner - Physician Assistant 9931383148 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kings Medical Family Practice, P.C.Group PAC ID 4082989645, 18 clinicians

Practice addresses (Care Compare)

1295 Broadway
Brooklyn, NY 11221-2973
Phone (718) 682-3903

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
006648NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Brookdale Hospital Medical Center Past Accepting new patients

Networks

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

Organizations & group practices 3

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": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411084800000",
    "number": "1043530769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1349 BROADWAY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112213618",
            "telephone_number": "718-975-2270",
            "fax_number": "718-975-2271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1349 BROADWAY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112213618",
            "telephone_number": "718-975-2270",
            "fax_number": "718-975-2271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLLISON",
        "first_name": "CECIL",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-03",
        "last_updated": "2014-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "006648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.