Individual provider Active NPI

Joann Mercedes, CPNP

  • Pediatric Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1174917926
Registry record updated Mar 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
F382480-1 Issued in NY
Practice address
3415 Bainbridge Ave
Bronx, NY 10467-2403
Phone
(718) 741-2450
NPI assigned
Mar 18, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered Nurse 163WP0200X 618865-1 NY
Pediatric Nurse Practitioner 363LP0200X F382480-1 NY Primary

Addresses

Primary practice location

3415 Bainbridge Ave
Bronx, NY 10467-2403

Mailing address

3415 Bainbridge Ave
Bronx, NY 10467-2403

Other identifiers 2

IdentifierTypeStateIssuer
F382480-1OtherNYPEDIATRIC NURSE PRACTITIONER LICENSE
618865-1OtherNYRN LICENSE

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
I20150924002923 NY Practitioner - Nurse Practitioner 0143538199 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
618865-1NYMDPediatric Registered Nurse
F382480-1NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince May 15, 2015 Accepting new patients
Montefiore Medical Center CurrentSince May 15, 2015 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

Networks

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

Organizations & group practices 2

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": "1426636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426723200000",
    "number": "1174917926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 BAINBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 BAINBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672403",
            "telephone_number": "718-741-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERCEDES",
        "first_name": "JOANN",
        "name_prefix": "Mrs.",
        "credential": "CPNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-18",
        "last_updated": "2015-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "NY",
            "license": "618865-1",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F382480-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEDIATRIC NURSE PRACTITIONER LICENSE",
            "identifier": "F382480-1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "618865-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.