NPIMap

Individual provider Active NPI

Michele Elizabeth Mordelle, PA

  • Physician Assistant
  • Mount Vernon, NY
National Provider Identifier
1316320385
Registry record updated Oct 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
18771 Issued in NY
Practice address
28 Farrell Ave
Mount Vernon, NY 10553-1806
Phone
(516) 663-8700
NPI assigned
Jul 8, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2024

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 18771 NY Primary

Addresses

Primary practice location

28 Farrell Ave
Mount Vernon, NY 10553-1806

Mailing address

28 Farrell Ave
Mount Vernon, NY 10553-1806

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwallace305970@nyumc.direct-ci.com Other NYU Langone

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190305001377 NY Practitioner - Physician Assistant 6406161652 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

259 1St St
Mineola, NY 11501-3957
Phone (516) 222-8600

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018771NYMDPediatric Occupational Therapist
18771NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Apr 22, 2019 Accepting new patients
New York University CurrentSince Apr 22, 2019 Accepting new patients

Locations

170 William St
New York, NY 10038
Phone (212) 238-0100

Networks

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

Interoperability endpoints

  • Direct secure messaging: mwallace844149@nychhc.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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": "1436313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728172800000",
    "number": "1316320385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 FARRELL AVE",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105531806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 FARRELL AVE",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105531806",
            "telephone_number": "516-663-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORDELLE",
        "first_name": "MICHELE",
        "middle_name": "ELIZABETH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-08",
        "last_updated": "2024-10-06",
        "certification_date": "2024-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "18771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwallace305970@nyumc.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "NYU Langone",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Other",
            "address_1": "28 Farrell Ave",
            "city": "Mount Vernon",
            "state": "NY",
            "country_code": "US",
            "postal_code": "105531806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Vernon, NY

Sources for this page

Verify at the official NPI Registry.