Individual provider Active NPI

Amelia De la Concha

  • Family Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1386020014
Registry record updated Aug 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F338406 Issued in NY
Practice address
3400 Bainbridge Ave
7TH Floor
Bronx, NY 10467-2404
Phone
(718) 920-2626
Fax
(718) 652-1833
NPI assigned
Aug 4, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F338406 NY Primary

Addresses

Primary practice location

3400 Bainbridge Ave
7TH Floor
Bronx, NY 10467-2404

Mailing address

1657 Paulding Ave
Ground Floor
Bronx, NY 10462-3106
Phone (347) 920-8503

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
I20160610000749 NY Practitioner - Nurse Practitioner 5799075396 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
May accept Medicare assignment
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

Hospital & facility affiliations

  • Montefiore Medical Center Hospital, Bronx, NY, CCN 330059

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F338406NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Apr 2, 2016 Accepting new patients
Montefiore Medical Center CurrentSince Apr 2, 2016 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1250 Waters Pl
Bronx, NY 10461
Phone (718) 409-9444

Networks

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

Organizations & group practices 2

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 1

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": "1438646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438646400000",
    "number": "1386020014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1657 PAULDING AVE",
            "address_2": "GROUND FLOOR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104623106",
            "telephone_number": "347-920-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 BAINBRIDGE AVE",
            "address_2": "7TH FLOOR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672404",
            "telephone_number": "718-920-2626",
            "fax_number": "718-652-1833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA CONCHA",
        "first_name": "AMELIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-04",
        "last_updated": "2015-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F338406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.