Individual provider Active NPI

Mohammadmehdi Omidvari, M.D.

  • Psychiatry Physician
  • Brooklyn, NY
National Provider Identifier
1194137760
Registry record updated May 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
292862 Issued in NY
Practice address
450 Clarkson Ave
Brooklyn, NY 11203-2012
Phone
(718) 270-2902
NPI assigned
May 29, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 292862 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

450 Clarkson Ave
Brooklyn, NY 11203-2012

Mailing address

450 Clarkson Ave
Brooklyn, NY 11203-2012
Phone (718) 270-2902

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
I20190912001947 NY Practitioner - Psychiatry 8921337155 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1123 Broadway
Suite 1117
New York, NY 10010-2007
Phone (646) 874-9340

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
292862NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bronx Medical Practice P.C. CurrentSince May 1, 2021 Accepting new patients
Essen Medical Associates, PC CurrentSince May 1, 2021 Accepting new patients
Urban Health Plan, Inc. CurrentSince Jul 27, 2019 Accepting new patients
Urban Health Plan, Inc. CurrentSince Jul 27, 2019 Accepting new patients
Essen Medical Associates,PC CurrentSince May 1, 2021 Accepting new patients
Essen Medical Associates, PC Current Accepting new patients
Omidvari Psychiatry P.C. Psychiatry CurrentSince Jan 20, 2025 Accepting new patients

Locations

2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

1065 Southern Blvd
Bronx, NY 10459
Phone 71858924404222

2015 Grand Concourse
#13202
Bronx, NY 10453

1515 Southern Blvd
#H
Bronx, NY 10460
Phone (718) 589-1600

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

1123 Broadway
Ste 1117
New York, NY 10010
Phone (212) 253-0030

154 W 127th St
New York, NY 10027
Phone (212) 280-0804

Organizations & group practices 7

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": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557964800000",
    "number": "1194137760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012",
            "telephone_number": "718-270-2902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012",
            "telephone_number": "718-270-2902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMIDVARI",
        "first_name": "MOHAMMADMEHDI",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-29",
        "last_updated": "2019-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "292862",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.