Erewarifagha Minini Haidome, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

403564 Issued in NY

Practice address

14036 170TH St
Jamaica, NY 11434-4632

Phone

(347) 843-7760

NPI assigned

Jul 13, 2015

Last updated

Nov 2, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Erewari Minini Peterside Professional name

Electronic endpoints 2

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Shakespeare Operating LLCGroup PAC ID 0840604310, 144 clinicians

Essen Medical Associates, PCGroup PAC ID 1759353501, 264 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

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

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.

• Essen Medical Associates, PC

  • Legal Medicine
  • Bronx, NY
  • NPI 1366418709
  Medicare reassignment Care Compare group NPD
• Shakespeare Operating LLC

  dba Bronx Treatment Center

  • Multi-Specialty Clinic/Center
  • Bronx, NY
  • NPI 1720634538
  Medicare reassignment Care Compare group NPD
• Bronx Medical Practice P.C.

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1356726087
  Medicare reassignment NPD
• Essen Medical Urgicare, PLLC

  dba Metro Urgicare

  • Urgent Care Clinic/Center
  • Bronx, NY
  • NPI 1841607298
  Medicare reassignment NPD
• House Call Medical Services of New York, PLLC

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1851345946
  Medicare reassignment NPD
• Rimisac Family Health NP PC

  • Contractor
  • Jamaica, NY
  • NPI 1083020242
  Medicare reassignment NPD
• Tusse Behavioral Wellness LLC

  • Occupational Health Nurse Practitioner
  • New York, NY
  • NPI 1992680292
  NPD Authorized official
• The Guidance Center of Westchester, Inc

  • Community/Behavioral Health Agency
  • Mount Vernon, NY
  • NPI 1861506974
  Medicare reassignment
• Essen Medical Associates, PC

  • Podiatrist
  • Bronx, NY
  • NPI 1720799158
  NPD
• Rimisac Family Health NP PC

  • Early Intervention Provider Agency
  • Bronx, NY
  • NPI 1881212645
  NPD
• The Guidance Center of Westchester

  • Community/Behavioral Health Agency
  • Mount Vernon, NY
  • NPI 1285218073
  NPD
• Coordinated Behavioral Care Ipa Inc

  • Multi-Specialty Clinic/Center
  • Bronx, NY
  • NPI 1457881443
  NPD (past)

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1114301728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3963 MURDOCK AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104662442",
            "telephone_number": "347-281-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14036 170TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114344632",
            "telephone_number": "347-843-7760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "391 E 149th St Rm 405",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104553907",
            "country_code": "US",
            "telephone_number": "718-215-1117",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "256 Washington St",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "NY",
            "postal_code": "105531052",
            "country_code": "US",
            "telephone_number": "914-613-0700 x7041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAIDOME",
        "first_name": "EREWARIFAGHA",
        "middle_name": "MININI",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-13",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "621055-1",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1114301728",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "MT.VERNON",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "256 WASIHINGTON ST",
            "city": "MT. VERNON",
            "state": "NY",
            "country_code": "US",
            "postal_code": "10553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Bronx",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "AWARD",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "BRONX",
            "address_1": "391 E 149th St Rm 405",
            "city": "Bronx",
            "state": "NY",
            "country_code": "US",
            "postal_code": "104553907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "EREWARI",
            "last_name": "PETERSIDE",
            "middle_name": "MININI",
            "prefix": "MISS",
            "credential": "NURSE PRACTITIONER",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Gabriel Hafisov
• Muhammad Abdul Hafiz, RVT
• Laura Hahn, PSY.D.
• Mohammad N Haider
• Sahar Farhan Haider, M.D
• Denise Haigood
• Farshad Haiimpour, O.D
• Fatemeh Hajighasemi, MD
• Ranya Victoria Hajjar
• Fnu Hakim, M.D

• Psychiatric/Mental Health Nurse Practitioner in Jamaica, NY
• Providers in Jamaica, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.