Individual provider Active NPI

Stephanie Ann Mohan, FNP

  • Family Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1154036523
Registry record updated Jun 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
351112 Issued in NY
Practice address
770 E 176TH St
Bronx, NY 10460-4617
Phone
(718) 466-8034
NPI assigned
Jan 19, 2023
Last updated
Jun 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 351112 NY Primary

Addresses

Primary practice location

770 E 176TH St
Bronx, NY 10460-4617

Mailing address

770 E 176TH St
Bronx, NY 10460-4617
Phone (718) 466-8034

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230912002732 NY Practitioner - Nurse Practitioner 4880058650 Reassigns benefits to 3 organizations
I20260326003755 CT Practitioner - Nurse Practitioner 4880058650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4055 Valley View LN
Suite 400
Dallas, TX 75244-4910

4055 Valley View LN
Suite 400
Dallas, TX 75244-5071

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
351112NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Symphony Medical PC CurrentSince Aug 1, 2024 Accepting new patients
Symphony Medical PC CurrentSince Aug 1, 2024 Accepting new patients
Symphony Medical PC Current Accepting new patients
Vocational Instruction Project Community Services Inc CurrentSince Jul 18, 2023 Accepting new patients
Brookview Medical Associates, PLLC CurrentSince Nov 1, 2025 Accepting new patients
Vocational Instruction Project Community Services, Inc. CurrentSince Jul 18, 2023 Accepting new patients
Vocational Instruction Project Community Services Inc PastSince Jun 21, 2020 Accepting new patients

Locations

80 Orville Dr
Ste 100
Bohemia, NY 11716
Phone (516) 308-6610

770 E 176th St
Bronx, NY 10460
Phone (718) 466-8034

770 E 176th St
Fl 2
Bronx, NY 10460
Phone (718) 583-5150

2 Park Ave
Yonkers, NY 10703
Phone (914) 964-7723

967 N Broadway
Yonkers, NY 10701
Phone (914) 798-8956

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Networks

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23390/brand/1/csg/1/fhir/r4
  • Direct secure messaging: stephanie.mohan@vipcs.eclinicaldirectplus.com

Organizations & group practices 8

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": "1674086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685750400000",
    "number": "1154036523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 E 176TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104604617",
            "telephone_number": "718-466-8034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 E 176TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104604617",
            "telephone_number": "718-466-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAN",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-19",
        "last_updated": "2023-06-03",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "351112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.