Individual provider Active NPI

Hiroshi Mitsumoto, M.D.

  • Neurology Physician
  • New York, NY
National Provider Identifier
1053480384
Registry record updated May 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
215790 Issued in NY
Practice address
710 W 168TH St
New York, NY 10032-3726
Phone
(212) 305-1319
Fax
(212) 305-2750
NPI assigned
Nov 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 215790 NY Primary

Addresses

Primary practice location

710 W 168TH St
New York, NY 10032-3726

Mailing address

710 W 168TH St
New York, NY 10032-3726
Phone (212) 305-1319

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040529000071 NY Practitioner - Neurology 4284615782 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
215790NYMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York Neurology CurrentSince Apr 1, 2018 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Apr 1, 2013 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Apr 1, 2013 Accepting new patients

Locations

51 W 51st St
Ste 360
New York, NY 10019
Phone (212) 326-8415

710 W 168th St
New York, NY 10032
Phone (212) 305-0217

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

710 W 168th St
#1125A
New York, NY 10032
Phone (212) 342-4437

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

Interoperability endpoints

  • Direct secure messaging: him9001@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338336000000",
    "number": "1053480384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323726",
            "telephone_number": "212-305-1319",
            "fax_number": "212-305-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323726",
            "telephone_number": "212-305-1319",
            "fax_number": "212-305-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITSUMOTO",
        "first_name": "HIROSHI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2012-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "215790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.