Individual provider Active NPI

Marisa Anne Greechan, RN, CPNP

  • Pediatric Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1356639041
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
382189 Issued in NY
Practice address
506 6TH Street
Dept of Pediatrics
Brooklyn, NY 11215
Phone
(718) 780-3838
NPI assigned
Jul 14, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 382189 NY Primary

Addresses

Primary practice location

506 6TH Street
Dept of Pediatrics
Brooklyn, NY 11215

Mailing address

506 6TH Street
Dept of Pediatrics
Brooklyn, NY 11215-3609
Phone (718) 780-3838

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)
Direct Messaging Address mag7025@direct.nyp.org Direct
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/ Health Information Exchange (HIE)

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
I20140408000722 NY Practitioner - Nurse Practitioner 5294967188 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
382189NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Dec 5, 2013 Accepting new patients
Kings Physician Services, PC CurrentSince Jan 27, 2020 Accepting new patients
Kings Physician Services, PC CurrentSince Jan 27, 2020 Accepting new patients
Montefiore Medical Center CurrentSince Dec 5, 2013 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

506 6th St
Ste B
Brooklyn, NY 11215
Phone (718) 780-3677

506 6th St
Brooklyn, NY 11215
Phone (718) 780-3279

1981 Marcus Ave
Ste 208
North New Hyde Park, NY 11042
Phone (718) 670-1415

Networks

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

Interoperability endpoints

  • Direct secure messaging: mag7025@direct.nyp.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1310601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1356639041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 6TH STREET",
            "address_2": "DEPT OF PEDIATRICS",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112153609",
            "telephone_number": "718-780-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 6TH STREET",
            "address_2": "DEPT OF PEDIATRICS",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11215",
            "telephone_number": "718-780-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREECHAN",
        "first_name": "MARISA",
        "middle_name": "ANNE",
        "credential": "RN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-14",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "382189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "506 6th Street",
            "address_2": "Dept of Pediatrics",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "11215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mag7025@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Address",
            "address_1": "506 6th Street",
            "address_2": "Dept of Pediatrics",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "11215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "506 6th Street",
            "address_2": "Dept of pediatrics",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "11215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.