Individual provider Active NPI

Mandisa Dalila Dennis, CRNA

  • Certified Registered Nurse Anesthetist
  • New York, NY
National Provider Identifier
1336258490
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
536950-01 Issued in NY
Practice address
170 William St
New York, NY 10038-2612
Phone
(803) 467-8058
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 536950-01 NY Primary

Addresses

Primary practice location

170 William St
New York, NY 10038-2612

Mailing address

575 Lexington Ave
New York, NY 10022-6102

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061114000160 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 7719985472 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

525 E 68TH St
New York, NY 10065-4870
Phone (212) 746-2846

Hospital & facility affiliations

  • New York-Presbyterian Hospital Hospital, New York, NY, CCN 330101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
536950-01NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Weill Medical College of Cornell CurrentSince Apr 1, 2020 Accepting new patients
Harlem Medical Associates PC CurrentSince Aug 26, 2013 Accepting new patients
Montefiore Medical Center CurrentSince May 10, 2024 Accepting new patients
North American Partners in Anesthesia LLP CurrentSince Jun 14, 2023 Accepting new patients
Weill Medical College of Cornell Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2020 Accepting new patients
Interfaith Professional Physician Services, P.C. CurrentSince Nov 15, 2022 Accepting new patients
New York Gi Center LLC CurrentSince Dec 20, 2014 Accepting new patients
Sedation Vacation Perioperative Medicine PLLC CurrentSince Jul 22, 2023 Accepting new patients
Montefiore Medical Center CurrentSince May 10, 2024 Accepting new patients
University Physicians of Brooklyn, Inc Past Accepting new patients

Locations

7 Southwoods Blvd
Ste 4
Albany, NY 12211

1200 Waters Pl
Ste M117
Bronx, NY 10461
Phone (718) 863-0575

111 E 210th St
Bronx, NY 10467

121 DeKalb Ave
Brooklyn, NY 11201
Phone (718) 250-6604

1396 Myrtle Ave
Brooklyn, NY 11237
Phone (718) 878-4313

1545 Atlantic Ave
Brooklyn, NY 11213
Phone (718) 613-4175

3122 Union St
Ste 1B
Flushing, NY 11354
Phone (718) 968-7171

1510 Jericho Tpke
New Hyde Park, NY 11040
Phone (516) 216-5341

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

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

10512 101st Ave
Ozone Park, NY 11416
Phone (718) 847-3600

Networks

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

Organizations & group practices 10

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 5

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1336258490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 LEXINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100226102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 WILLIAM ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100382612",
            "telephone_number": "803-467-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENNIS",
        "first_name": "MANDISA",
        "middle_name": "DALILA",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "536950-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.