Individual provider Active NPI

Andie Brett Bodian, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1215735782
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
034654 Issued in NY
Practice address
622 W 168TH St
VC2-260
New York, NY 10032-3720
Phone
(212) 305-6204
NPI assigned
Mar 3, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 034654 NY Primary

Addresses

Primary practice location

622 W 168TH St
VC2-260
New York, NY 10032-3720

Mailing address

622 W 168TH St
New York, NY 10032-3720

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
I20251030000279 NY Practitioner - Physician Assistant 1557850559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
George Washington University School of Medicine, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

200 W Martin Luther King Blvd
Suite 1000
Chattanooga, TN 37402-2560

400 Kelby St
FL 9
Fort Lee, NJ 07024-2939

622 W 168TH St
New York, NY 10032-3796

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
034654NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York Physician Assistant CurrentSince Sep 26, 2025 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Sep 26, 2025 Accepting new patients

Locations

622 W 168th St
#2260
New York, NY 10032
Phone (212) 305-6204

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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": "1740960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1215735782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "address_2": "VC2-260",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODIAN",
        "first_name": "ANDIE",
        "middle_name": "BRETT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-03",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "034654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.