Individual provider Active NPI

Michael Sivilli

  • Physician Assistant
  • Bronx, NY
National Provider Identifier
1063210128
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1250 Waters PL
Bronx, NY 10461-2720
Phone
(718) 920-2060
NPI assigned
Mar 5, 2025
Last updated
Mar 5, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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 Primary

Addresses

Primary practice location

1250 Waters PL
Bronx, NY 10461-2720

Mailing address

23 Tardy LN N
Wantagh, NY 11793-1928

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
I20251111000965 NY Practitioner - Physician Assistant 1456842152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
033451NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Current Accepting new patients
Montefiore Medical Center CurrentSince Aug 23, 2025 Accepting new patients
Montefiore Medical Center CurrentSince Aug 23, 2025 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1250 Waters Pl
Bronx, NY 10461
Phone (718) 409-9444

Networks

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

Interoperability endpoints

  • Direct secure messaging: msivilli@montefioredirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1741132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1063210128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 TARDY LN N",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117931928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 WATERS PL",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612720",
            "telephone_number": "718-920-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVILLI",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-05",
        "last_updated": "2025-03-05",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.