Individual provider Active NPI

Heysook Park Wanta

  • Gastroenterology Physician
  • New York, NY
National Provider Identifier
1164964680
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
F339118 Issued in NY
Practice address
1315 York Ave
New York, NY 10021-5304
Phone
(212) 746-5077
NPI assigned
Nov 15, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X F339118 NY Primary

Addresses

Primary practice location

1315 York Ave
New York, NY 10021-5304

Mailing address

568 Ashford Ave
Ardsley, NY 10502-1602
Phone (917) 843-5667

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
I20170919000985 NY Practitioner - Nurse Practitioner 8921372681 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

1305 York Ave
FL 4
New York, NY 10021-5663
Phone (646) 962-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F339118NYMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Weill Medical College of Cornell Gastroenterology CurrentSince Aug 19, 2017 Accepting new patients
Weill Medical College of Cornell CurrentSince Aug 19, 2017 Accepting new patients
Cornell University Medical College Past Accepting new patients

Locations

1305 York Ave
New York, NY 10021
Phone (646) 962-2020

1315 York Ave
New York, NY 10021
Phone (212) 746-5077

525 E 68th St
Rm J314
New York, NY 10065
Phone (212) 746-4158

525 E 68th St
#J314
New York, NY 10065
Phone (212) 746-4158

1305 York Ave
Fl 4
New York, NY 10021
Phone (646) 962-4000

Networks

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

Interoperability endpoints

  • Direct secure messaging: hep9028@direct.nyp.org

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1479168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1164964680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 ASHFORD AVE",
            "city": "ARDSLEY",
            "state": "NY",
            "postal_code": "105021602",
            "telephone_number": "917-843-5667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100215304",
            "telephone_number": "212-746-5077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANTA",
        "first_name": "HEYSOOK",
        "middle_name": "PARK",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-15",
        "last_updated": "2021-10-14",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "F339118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.