Individual provider Active NPI

Lilian Udo, NP

  • Family Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1104461912
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
347448 Issued in NY
Practice address
1650 Grand Concourse
Bronx, NY 10457-7679
Phone
(718) 992-7669
NPI assigned
Nov 15, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 545356 NY
Family Nurse Practitioner 363LF0000X 347448 NY Primary

Addresses

Primary practice location

1650 Grand Concourse
Bronx, NY 10457-7679

Mailing address

1650 Grand Concourse
Bronx, NY 10457-7679
Phone (718) 992-7669

Other practice location 1

500 Bergen Ave
Bronx, NY 10455-4048
Phone (718) 401-5140

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
I20220310002800 NY Practitioner - Nurse Practitioner 6406241306 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bronxcare Health SystemGroup PAC ID 3870404429, 335 clinicians

Practice addresses (Care Compare)

1650 Grand Concourse
FL 12
Bronx, NY 10457-7606
Phone (718) 518-5222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
545356NYMDMedical-Surgical Registered Nurse
347448NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Director Services PC CurrentSince Oct 30, 2021 Accepting new patients
Bronxcare Health System CurrentSince Feb 3, 2024 Accepting new patients
Bronxcare Health System CurrentSince Feb 3, 2024 Accepting new patients
Rising Ground. Inc PastSince Nov 1, 2019 Accepting new patients

Locations

1650 Grand Concourse
Fl 12
Bronx, NY 10457
Phone (718) 518-5222

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

1276 Fulton Ave
Bronx, NY 10456
Phone (718) 518-5000

50 Sheffield Ave
Brooklyn, NY 11207
Phone (718) 250-8789

1311 Virginia St
Far Rockaway, NY 11691
Phone (718) 327-2908

Networks

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

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1104461912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577679",
            "telephone_number": "718-992-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577679",
            "telephone_number": "718-992-7669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Bergen Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104554048",
            "country_code": "US",
            "telephone_number": "718-401-5140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UDO",
        "first_name": "LILIAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-15",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "NY",
            "license": "545356",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "347448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.