Individual provider Active NPI

Thomas Walsh, A.N.P

  • Adult Health Nurse Practitioner
  • Staten Island, NY
National Provider Identifier
1285756577
Registry record updated Oct 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
306239 Issued in NY
Practice address
4771 Hylan Blvd
Staten Island, NY 10312
Phone
(718) 948-8200
Fax
(718) 420-2718
NPI assigned
Apr 6, 2007
Last updated
Oct 1, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 306239 NY Primary

Addresses

Primary practice location

4771 Hylan Blvd
Staten Island, NY 10312

Mailing address

55 Water St
2ND Floor Cred Dept
New York, NY 10041-0004
Phone (646) 680-2888

Other practice location 1

4771 Hylan Blvd
Staten Island, NY 10312
Phone (718) 948-8200

Other practice location 2

4771 Hylan Blvd
Staten Island, NY 10312
Phone (718) 948-8200

Other practice location 3

4771 Hylan Blvd
Staten Island, NY 10312
Phone (718) 948-8200

Other practice location 4

1050 Clove Road
Staten Island, NY 10301-3627
Phone (718) 816-6440

Other identifiers 1

IdentifierTypeStateIssuer
03512961MedicaidNY

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
I20121204000008 NY Practitioner - Nurse Practitioner 7719163476 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantagecare Physicians PC CurrentSince Jan 1, 2017 Accepting new patients
Advantagecare Physicians PC CurrentSince Jan 1, 2017 Accepting new patients

Locations

233 Nostrand Ave
Brooklyn, NY 11205
Phone (646) 680-1595

55 Water St
Fl 2
New York, NY 10041

1050 Clove Rd
Staten Island, NY 10301
Phone (718) 816-6440

4771 Hylan Blvd
Staten Island, NY 10312
Phone (718) 948-8200

Interoperability endpoints

  • FHIR API: https://epwebapps.acpny.com/FHIRproxy/ACPNY/api/FHIR/R4

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, 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": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1285756577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WATER ST",
            "address_2": "2ND FLOOR CRED DEPT",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100410004",
            "telephone_number": "646-680-2888",
            "fax_number": "516-542-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4771 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10312",
            "telephone_number": "718-948-8200",
            "fax_number": "718-420-2718"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4771 Hylan Blvd",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "10312",
            "country_code": "US",
            "telephone_number": "718-948-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4771 Hylan Blvd",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "10312",
            "country_code": "US",
            "telephone_number": "718-948-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4771 Hylan Blvd",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "10312",
            "country_code": "US",
            "telephone_number": "718-948-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 Clove Road",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103013627",
            "country_code": "US",
            "telephone_number": "718-816-6440",
            "fax_number": "718-816-3611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALSH",
        "first_name": "THOMAS",
        "credential": "A.N.P",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "306239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03512961",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.