Concourse Medical Center Inc

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

090111295 Issued in NY

Legal business name

CONCOURSE MEDICAL CENTER INC

Practice address

880 Morris Ave
Bronx, NY 10451-3412

Phone

(718) 665-9340

NPI assigned

May 22, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Ana Matos, CASAC ADVANCEDNPI 1013381623

Title

Executive Director

Phone

(718) 665-9340

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NY

Opioid treatment program

Medicare-enrolled since May 28, 2024

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ana Mercedes Matos

  • Addiction (Substance Use Disorder) Counselor
  • Bronx, NY
  • NPI 1013381623
  NPD Authorized official
• Carol Blackwell

  • Addiction (Substance Use Disorder) Counselor
  • Bronx, NY
  • NPI 1851765358
  NPD (past)
• Jacqueline Butler, RPA

  • Physician Assistant
  • Bronx, NY
  • NPI 1851559108
  NPD (past)
• Laurence Geller

  • Behavior Analyst
  • Bronx, NY
  • NPI 1285008821
  NPD (past)
• Maritza Monserrat, LPN

  • Licensed Practical Nurse
  • Bronx, NY
  • NPI 1346614955
  NPD (past)
• Yanira Delia Morales

  • Addiction (Substance Use Disorder) Counselor
  • Bronx, NY
  • NPI 1396119897
  NPD (past)
• Jesse Paez

  • Marriage & Family Therapist
  • Bronx, NY
  • NPI 1497185151
  NPD (past)
• Jeanette Perez

  • Addiction (Substance Use Disorder) Counselor
  • Bronx, NY
  • NPI 1598139081
  NPD (past)
• Efrain Torres

  • Addiction (Substance Use Disorder) Counselor
  • Bronx, NY
  • NPI 1073987673
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1073722286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 MORRIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104513412",
            "telephone_number": "718-665-9340",
            "fax_number": "718-665-2394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 MORRIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104513412",
            "telephone_number": "718-665-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCOURSE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A",
        "authorized_official_last_name": "MATOS",
        "authorized_official_first_name": "ANA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "718-665-9340",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CASAC ADVANCED"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NY",
            "license": "090111295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02243034",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "A300233658",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "A400073294",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Concordia Pharma Inc
• Concourse Cardiology Associates, P.C.
• Concourse Chiropractic PLLC
• Concourse Diagnostic Inc
• Concourse Drugs Inc.
• Concourse Medical Office P C
• Concourse Pediatrics
• Concourse Pharmacy Inc.
• Concourse Plaza Dental Associates PC
• Concourse Plaza Family Dental LLC

• Methadone Clinic in Bronx, NY
• Providers in Bronx, NY by specialty
• Methadone Clinic in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.