Jack Mohadeb, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

014776-1 Issued in NY

Practice address

1977 E 15TH St
Brooklyn, NY 11229-3307

Phone

(917) 751-6126

NPI assigned

Jun 6, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Physician Affiliate Group of New York PCGroup PAC ID 4688098833, 1,222 clinicians

New York City Health and Hospitals CorporationGroup PAC ID 4183535305, 543 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• South Brooklyn Health Hospital, Brooklyn, NY, CCN 330196

Merit-based Incentive Payment System (MIPS)

Final score

76 of 100Reported as individual

Quality

90

Improvement activities

0

Cost

100

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

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

Interoperability endpoints

• Direct secure messaging: jmohadeb4495457@nychhc.direct-ci.com

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.

• New York City Health and Hospitals Corporation

  dba Gouverneur Healthcare Services

  • Clinic/Center
  • New York, NY
  • NPI 1548208127
  Medicare reassignment Care Compare group
• Physician Affiliate Group of New York PC

  • Registered Dietitian
  • New York, NY
  • NPI 1013375526
  Medicare reassignment Care Compare group
• A&I Medical P.C.

  • Urology Physician
  • Brooklyn, NY
  • NPI 1104001593
  Medicare reassignment
• New York City Health and Hospitals Corporation

  dba Jacobi Medical Center

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1679587679
  NPD (past)
• Paramount Anesthesia Practice PC

  • Anesthesiology Physician
  • Brooklyn, NY
  • NPI 1275783789
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• New York City Health and Hospitals Corporation

  dba Coney Island Hospital

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1124032982
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414108800000",
    "number": "1326451337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1977 E 15TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112293307",
            "telephone_number": "917-751-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1977 E 15TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112293307",
            "telephone_number": "917-751-6126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHADEB",
        "first_name": "JACK",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-06",
        "last_updated": "2014-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014776-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE#",
            "identifier": "014776-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Polina Mograchyova, MS ED
• Dieudonne Mogwom
• Jessica Moh, DDS
• Shaina Mohaber, RN
• Amelia Mohabir, R.P.A.-C
• Sara Mohadeb
• Nathalie S Mohadjeri, D.M.D
• A. Hassan Mohaideen, MD
• Kambiz Mohajer, DMD
• Nehal Mohamed Elfeky, PHARMD

• Physician Assistant in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.