Individual provider Active NPI

Masood Temitope Usman, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1104690676
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1445 E 87TH St
Brooklyn, NY 11236-5137
Phone
(917) 705-5767
NPI assigned
Nov 14, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1445 E 87TH St
Brooklyn, NY 11236-5137

Mailing address

1445 E 87TH St
Brooklyn, NY 11236-5137
Phone (917) 705-5767

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
I20250428002059 NY Practitioner - Physician Assistant 2860918414 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Feb 16, 2025 Accepting new patients
Montefiore Medical Center CurrentSince Feb 16, 2025 Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

Networks

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

Interoperability endpoints

  • Direct secure messaging: musman3556833@nychhc.direct-ci.com
  • Direct secure messaging: musman@montefioredirect.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1699920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1104690676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 E 87TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112365137",
            "telephone_number": "917-705-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 E 87TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112365137",
            "telephone_number": "917-705-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "USMAN",
        "first_name": "MASOOD",
        "middle_name": "TEMITOPE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-14",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.