Concourse Village Primary Care PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

211364 Issued in NY

Legal business name

CONCOURSE VILLAGE PRIMARY CARE PLLC

Practice address

769 Concourse VLG W
Bronx, NY 10451-3801

Phone

(718) 402-4021

Fax

(718) 402-4023

NPI assigned

Feb 25, 2008

Last updated

Feb 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jean R. MacenatNPI 1104886860

Title

President

Phone

(718) 402-4021

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BEFGAA

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jean Robert Macenat, M.D

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1104886860
  Medicare reassignment NPD Authorized official
• Walces Castelly, PA

  • Medical Physician Assistant
  • Glendale, AZ
  • NPI 1568006682
  NPD (past)

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

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1093984981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "769 CONCOURSE VLG W",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104513801",
            "telephone_number": "718-402-4021",
            "fax_number": "718-402-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "769 CONCOURSE VLG W",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104513801",
            "telephone_number": "718-402-4021",
            "fax_number": "718-402-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCOURSE VILLAGE PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "MACENAT",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-402-4021",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "211364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/SHIELD",
            "identifier": "JM0301AR0",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Concourse Pharmacy Inc.
• Concourse Plaza Dental Associates PC
• Concourse Plaza Family Dental LLC
• Concourse Rehab & Nursing Ctr Inc.
• Concourse Replacement LLC (Grand Concourse Dialysis Facility)
• Concourse West Dental PLLC
• Concourse West Management Inc
• Maria Conde-Rojas
• Loismarie Dangazo Condeza
• Nana Condua

• Specialist in Bronx, NY
• Providers in Bronx, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.