Simon Grecel Mendez Bustamante, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Nyc, NY
NPI 1306369608 · NPPES record last updated Jul 19, 2017
Key facts
- NPI
- 1306369608
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1400 Pelham Parkway South Bronx
Jacobi Medical Center
Nyc, NY 10461 - Phone
- (718) 918-5000
- NPI assigned
- Jul 19, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Hospitalist
- Education
- Other, 2011
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Montefiore Medical Center
Practice addresses (Care Compare)
600 E 233Rd St
Bronx, NY 10466-2604
Phone (718) 920-9000
Hospital & facility affiliations
- Montefiore Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200826002072 | NY | Practitioner - Hospitalist | 0941627640 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles (2 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montefiore Medical Center | Current |
Accepting new patients | |
| Montefiore Medical Center | Current |
Accepting new patients |
Locations
111 E 210th St
Bronx, NY 10467
600 E 233rd St
Bronx, NY 10466
Phone (718) 920-1640
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Interoperability endpoints
- smendezbus@montefioredirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1400 Pelham Parkway South Bronx
Jacobi Medical Center
Nyc, NY 10461
Mailing address
1400 Pelham Parkway South Bronx
Jacobi Medical Center
Nyc, NY 10461
Other providers in Nyc, NY
- Bonita Lippman-Hoskins
- MCC-Ny
- Maureen Eileen McGovern
- Harriet E McGurk
- Aliza Mendel
- Jocelyn F Mendoza
- Metro Physical Therapy
- Michael S. Goodman, DDS, PC
- Rosemary Milian
- Carl Nelke
All providers in Nyc, NY · Student in an Organized Health Care Education/Training Program in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.