Individual provider Active NPI

Ian Alexander Mellis, MD, PHD

  • Clinical Pathology Physician
  • New York, NY
National Provider Identifier
1366022915
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology PhysicianTaxonomy code 207ZC0006X
License
327229 Issued in NY
Practice address
622 W 168TH St
New York, NY 10032-3720
Phone
(212) 305-5697
NPI assigned
Apr 8, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology Physician 207ZC0006X 327229 NY Primary
Blood Banking & Transfusion Medicine Physician 207ZB0001X 327229 NY
Chemical Pathology Physician 207ZP0104X 327229 NY
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X 327229 NY

Addresses

Primary practice location

622 W 168TH St
New York, NY 10032-3720

Mailing address

630 West 168TH St
PH 1564W
New York, NY 10032

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250619002244 NY Practitioner - Pathology 4981115573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trustees of Columbia University in the City of New YorkGroup PAC ID 8527972546, 2,262 clinicians

Practice addresses (Care Compare)

622 W 168TH St
New York, NY 10032-3720
Phone (212) 305-9876

Hospital & facility affiliations

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
327229NYMDBlood Banking & Transfusion Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince May 21, 2025 Accepting new patients
Trustees of Columbia University in the City of New York Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince May 21, 2025 Accepting new patients

Locations

630 W 168th St
Ph 1564W
New York, NY 10032
Phone (212) 305-7399

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
Ph 1564
New York, NY 10032
Phone (212) 305-7399

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 3

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": "1617840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1366022915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 WEST 168TH ST",
            "address_2": "PH 1564W",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-5697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLIS",
        "first_name": "IAN",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-08",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "NY",
            "license": "327229",
            "primary": true
        },
        {
            "code": "207ZB0001X",
            "taxonomy_group": "",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": "NY",
            "license": "327229",
            "primary": false
        },
        {
            "code": "207ZP0104X",
            "taxonomy_group": "",
            "desc": "Pathology, Chemical Pathology",
            "state": "NY",
            "license": "327229",
            "primary": false
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "NY",
            "license": "327229",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.