Individual provider Active NPI

Shari Diane Reitzen-Bastidas, M.D.

  • Facial Plastic Surgery Physician
  • New York, NY
National Provider Identifier
1225173370
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X
License
240998 Issued in NY
Practice address
715 Park Ave Ste 2
New York, NY 10021-5047
Phone
(347) 557-8368
Fax
(646) 304-1278
NPI assigned
Feb 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Facial Plastic Surgery Physician 207YS0123X 240998 NY Primary

Addresses

Primary practice location

715 Park Ave Ste 2
New York, NY 10021-5047

Mailing address

715 Park Ave Ste 2
New York, NY 10021-5047
Phone (347) 557-8368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20101006001020 NY Practitioner - Otolaryngology 1658421276 Reassigns benefits to 1 organization
I20131223000029 NJ Practitioner - Otolaryngology 1658421276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
New York University School of Medicine, 2004
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

715 Park Ave
Suite 2
New York, NY 10021-5047
Phone (347) 557-8368

Merit-based Incentive Payment System (MIPS)

Final score
85.15 of 100Reported as group
Quality
71.59
Promoting interoperability
100
Improvement activities
40
Cost
76.65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
240998NYMDFacial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC CurrentSince Aug 1, 2016 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Aug 1, 2016 Accepting new patients
NS Medical PLLC CurrentSince Dec 7, 2022 Accepting new patients
Ffsnyc, LLC Current Accepting new patients
TBHC Physician Services PC Past Accepting new patients
Advanced Laparoscopic Associates Past Accepting new patients
University of Miami Past Accepting new patients

Locations

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

1111 Hudson St
Hoboken, NJ 07030
Phone (201) 942-9314

255 State Rt 3
Secaucus, NJ 07094
Phone (201) 216-9791

38 Meadowlands Pkwy
Ste 2
Secaucus, NJ 07094
Phone (201) 864-6868

3403 S Delsea Dr
Vineland, NJ 08360
Phone (856) 293-6974

Networks

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

Interoperability endpoints

  • Direct secure messaging: sreitzenbastidas681541@nychhc.direct-ci.com
  • Direct secure messaging: sreitzenbastidas67568@northwell.direct-ci.com
  • Direct secure messaging: sreitzenbastidas77267@direct.optum.com

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, 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": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1225173370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 PARK AVE STE 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100215047",
            "telephone_number": "347-557-8368",
            "fax_number": "646-304-1278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 PARK AVE STE 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100215047",
            "telephone_number": "347-557-8368",
            "fax_number": "646-304-1278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REITZEN-BASTIDAS",
        "first_name": "SHARI",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-20",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "NY",
            "license": "240998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.