Individual provider Active NPI

Sherissa Charles, M.D.

  • Family Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1235518978
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
292111 Issued in NY
Practice address
3080 Atlantic Ave
Brooklyn, NY 11208-1268
Phone
(718) 647-0240
NPI assigned
May 27, 2015
Last updated
Oct 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 292111 NY Primary

Addresses

Primary practice location

3080 Atlantic Ave
Brooklyn, NY 11208-1268

Mailing address

13303 Jamaica Ave
Jamaica, NY 11418-2618
Phone (718) 206-6942

Other identifiers 1

IdentifierTypeStateIssuer
05269856MedicaidNY

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
I20180802002497 NY Practitioner - Family Practice 4789932096 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Medical CenterGroup PAC ID 4082518006, 83 clinicians
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

1000 N Village Ave
Rockville Center, NY 11570-1000
Phone (516) 705-3428

2000 N Village Ave
Rockville Centre, NY 11570-1078
Phone (631) 376-3131

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Medical Center CurrentSince Aug 28, 2023 Accepting new patients
CHS Physician Partners, P.C CurrentSince Aug 28, 2023 Accepting new patients
CHS Physician Partners, PC Current Accepting new patients
Jamaica Hospital CurrentSince Jul 1, 2019 Accepting new patients
Mercy Medical Center CurrentSince Aug 28, 2023 Accepting new patients
Jamaica Hospital CurrentSince Jul 1, 2019 Accepting new patients
CHS Physician Partners, PC CurrentSince Aug 28, 2023 Accepting new patients

Locations

3080 Atlantic Ave
Brooklyn, NY 11208
Phone (718) 647-0240

18803 Jamaica Ave
Jamaica, NY 11423
Phone (718) 740-2060

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

2000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1777

2000 N Village Ave
Ste 208
Rockville Ctr, NY 11570
Phone (516) 766-0500

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

Networks

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

Interoperability endpoints

  • Direct secure messaging: scharles158969@direct-chsli.net
  • Direct secure messaging: scharles42253@direct.medisys.org

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.

Hospital & facility affiliations 4

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": "1432684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1235518978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13303 JAMAICA AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114182618",
            "telephone_number": "718-206-6942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 ATLANTIC AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112081268",
            "telephone_number": "718-647-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLES",
        "first_name": "SHERISSA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-27",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "292111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05269856",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.