Individual provider Active NPI

Carissa Radziewicz, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1316496102
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
020163 Issued in NY
Practice address
1 Gustave L Levy PL
New York, NY 10029-6504
Phone
(212) 241-6500
NPI assigned
Sep 22, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 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 020163 NY Primary

Addresses

Primary practice location

1 Gustave L Levy PL
New York, NY 10029-6504

Mailing address

5 E 98TH St FL 6
New York, NY 10029-6501
Phone (951) 234-4222

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
I20210913003036 NY Practitioner - Physician Assistant 5193121317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

5 E 98TH St
New York, NY 10029-6501
Phone (212) 241-0045

One Gustave L Levy Place
New York, NY 10029-6574
Phone (212) 241-0045

Hospital & facility affiliations

  • Mount Sinai Hospital Hospital, New York, NY, CCN 330024

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
020163NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Jul 1, 2021 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jul 1, 2021 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

625 Madison Ave
Fl 2
New York, NY 10022
Phone (212) 241-4812

10 Union Sq E
Ste 3A
New York, NY 10003
Phone (212) 844-8100

150 E 42nd St
New York, NY 10017
Phone (212) 661-8139

425 W 59th St
Ste 4F
New York, NY 10019
Phone (212) 241-1272

5 E 98th St
Fl 6
New York, NY 10029
Phone (212) 241-2221

1090 Amsterdam Ave
Ste 7G
New York, NY 10025
Phone (212) 362-7160

Networks

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

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 6

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": "1474502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1316496102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 E 98TH ST FL 6",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296501",
            "telephone_number": "951-234-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296504",
            "telephone_number": "212-241-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADZIEWICZ",
        "first_name": "CARISSA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-22",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.