Boram Song

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

26NJ00890500 Issued in NJ

Practice address

200 Grand Ave Ste 201
Englewood, NJ 07631-4363

Phone

(201) 944-3800

Fax

(201) 944-3804

NPI assigned

Jun 22, 2015

Last updated

Sep 8, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Boram Song Other name

Medicare fee-for-service enrollment

Enrolled in NY, NJ2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Group practices

Perry Ave Family Medical Center IncGroup PAC ID 0547365363, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

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

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Perry Ave Family Medical Center Inc

  • Family Medicine Physician
  • Bronx, NY
  • NPI 1619973518
  Medicare reassignment Care Compare group NPD
• Son Dermatology, PC

  • Dermatology Physician
  • Englewood, NJ
  • NPI 1679700868
  Medicare reassignment NPD
• Bronx Medical Practice P.C.

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1356726087
  Medicare reassignment
• Essen Medical Associates,PC

  • Legal Medicine (M.D./D.O.) Physician
  • Jamaica, NY
  • NPI 1700023926
  NPD (past)

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

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1063894475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 GRAND AVE STE 201",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314363",
            "telephone_number": "201-944-3800",
            "fax_number": "201-944-3804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GRAND AVE STE 201",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314363",
            "telephone_number": "201-944-3800",
            "fax_number": "201-944-3804"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "243 Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "NJ",
            "postal_code": "071056501",
            "country_code": "US",
            "telephone_number": "201-944-3800",
            "fax_number": "201-944-3804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "BORAM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-22",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F339122",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00890500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BORAM",
            "last_name": "SONG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Son Dermatology, PC
• Chang Bae Son, MD
• Seo Young Son, NP-C
• Songah Lisa Sone, RPH
• Song Acupower Wellness
• Erica Yoon-Jung Song, M.D.
• Eugene Song
• Susan Song
• Jade Soriano
• Norberto Luke Soto, M.D.

• Family Nurse Practitioner in Englewood, NJ
• Providers in Englewood, NJ by specialty
• Family Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.