Individual provider Active NPI

Manuel Eligio Mejia, MD

  • Internal Medicine Physician
  • Bronx, NY
National Provider Identifier
1114035193
Registry record updated Aug 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
241121 Issued in NY
Practice address
1831 Grand Concourse FRNT a
Bronx, NY 10453-6324
Phone
(347) 577-5704
Fax
(347) 577-5803
NPI assigned
Aug 29, 2006
Last updated
Aug 28, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 241121 NY Primary

Addresses

Primary practice location

1831 Grand Concourse FRNT a
Bronx, NY 10453-6324

Mailing address

1831 Grand Concourse FRNT a
Bronx, NY 10453-6324
Phone (347) 577-5804

Other practice location 1

66 Fort Washington Ave
New York, NY 10032-4711
Phone (646) 484-5455

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061025000184 NY Practitioner - Internal Medicine 9335146984 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1831 Grand Concourse
FRNT a
Bronx, NY 10453-6324
Phone (347) 577-5804

66 Fort Washington Ave
New York, NY 10032-4711
Phone (646) 484-5455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
241121NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Concourse Medical Practice, P.C. Internal Medicine CurrentSince Aug 23, 2010 Accepting new patients
Omni Medical of Ny, PC PastSince Aug 23, 2010 Accepting new patients

Locations

1831 Grand Concourse
Frnt A
Bronx, NY 10453
Phone (347) 577-5804

Networks

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GEECBA
  • FHIR API: https://fhir4.healow.com/fhir/r4/GEECBA/Endpoint/GEECBA
  • FHIR API: https://fhir4.healow.com/fhir/r4/JDACBD/Endpoint/JDACBD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787875200000",
    "number": "1114035193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 GRAND CONCOURSE FRNT A",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104536324",
            "telephone_number": "347-577-5804",
            "fax_number": "347-577-5803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1831 GRAND CONCOURSE FRNT A",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104536324",
            "telephone_number": "347-577-5704",
            "fax_number": "347-577-5803"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "66 Fort Washington Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100324711",
            "country_code": "US",
            "telephone_number": "646-484-5455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEJIA",
        "first_name": "MANUEL",
        "middle_name": "ELIGIO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "241121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.