Individual provider Active NPI

Nyarai Chinyani Mushonga, MD

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • St Petersburg, FL
National Provider Identifier
1063696763
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
MD471825 Issued in PA
Practice address
700 6TH St S FL 2
St Petersburg, FL 33701-4815
Phone
(727) 553-7461
Fax
(727) 553-7462
NPI assigned
Dec 18, 2007
Last updated
Jun 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician 2088F0040X ME124118 FL
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X MD471825 PA Primary
Obstetrics & Gynecology Physician 207V00000X MD471825 PA
Obstetrics & Gynecology Physician 207V00000X 25MA09160500 NJ
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician 2088F0040X 25MA09160500 NJ

Addresses

Primary practice location

700 6TH St S FL 2
St Petersburg, FL 33701-4815

Mailing address

700 6TH St S FL 2
St Petersburg, FL 33701-4815
Phone (727) 553-7461

Other practice location 1

24 Antrim Commons Dr
Greencastle, PA 17225-1623
Phone (717) 851-2443

Other identifiers 2

IdentifierTypeStateIssuer
0583588MedicaidNJ
122385100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20151222002519 FL Practitioner - Obstetrics/Gynecology 9234430927 Reassigns benefits to 1 organization
I20171017001735 NJ Practitioner - Obstetrics/Gynecology 9234430927 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ohi West Medical Group LLCGroup PAC ID 2668882507, 200 clinicians

Practice addresses (Care Compare)

700 6TH St S
FL 2
St Petersburg, FL 33701-4815
Phone (727) 893-6198

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD471825PAMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician
ME124118FLMDFemale Pelvic Medicine and Reconstructive Surgery (Urology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Newark Community Health Centers, Inc CurrentSince Feb 1, 2020 Accepting new patients
Ohi West Medical Group, LLC CurrentSince Jul 1, 2024 Accepting new patients
Newark Community Health Centers, Inc. CurrentSince Feb 1, 2020 Accepting new patients
Ohi West Medical Group, LLC CurrentSince Jul 1, 2024 Accepting new patients
New Jersey Urology LLC CurrentSince Oct 16, 2017 Accepting new patients

Locations

701 6th St S
St Petersburg, FL 33701
Phone (727) 450-1144

700 6th St S
Fl 2
St Petersburg, FL 33701
Phone (727) 893-6198

36 Newark Ave
Ste 200
Belleville, NJ 07109
Phone (973) 759-6180

741 Broadway
Newark, NJ 07104
Phone (973) 483-1300

375 Mount Pleasant Ave
Ste 250
West Orange, NJ 07052
Phone (973) 323-1300

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: nmushonga191217@ahs.direct-ci.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/HBFIAA
  • Direct secure messaging: nmushonga9991@njurology.direct-ci.com

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": "1197936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1063696763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 6TH ST S FL 2",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014815",
            "telephone_number": "727-553-7461",
            "fax_number": "727-553-7462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 6TH ST S FL 2",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337014815",
            "telephone_number": "727-553-7461",
            "fax_number": "727-553-7462"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Antrim Commons Dr",
            "address_purpose": "LOCATION",
            "city": "Greencastle",
            "state": "PA",
            "postal_code": "172251623",
            "country_code": "US",
            "telephone_number": "717-851-2443",
            "fax_number": "717-851-6129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUSHONGA",
        "first_name": "NYARAI",
        "middle_name": "CHINYANI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-18",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "FL",
            "license": "ME124118",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "PA",
            "license": "MD471825",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MD471825",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "25MA09160500",
            "primary": false
        },
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "NJ",
            "license": "25MA09160500",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0583588",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122385100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.