Individual provider Active NPI

Aboulaye Sidibe, PA-C

  • Physician Assistant
  • Mount Vernon, NY
National Provider Identifier
1396104048
Registry record updated Feb 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
181 Pearsall Dr
Apt 1B
Mount Vernon, NY 10552-3946
Phone
(914) 668-7432
NPI assigned
Feb 22, 2016
Last updated
Feb 22, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

181 Pearsall Dr
Apt 1B
Mount Vernon, NY 10552-3946

Mailing address

181 Pearsall Dr
Apt 1B
Mount Vernon, NY 10552-3946
Phone (914) 668-7432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, GA2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180606001204 NY Practitioner - Physician Assistant 0840555223 Reassigns benefits to 1 organization
I20211013000595 GA Practitioner - Physician Assistant 0840555223 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.24 of 100Reported as group
Quality
73.72
Promoting interoperability
100
Improvement activities
40
Cost
75.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation Inc CurrentSince Nov 4, 2021 Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Nov 4, 2021 Accepting new patients
Fpa Hospital Based CurrentSince Jun 1, 2018 Accepting new patients
Fpa Hospital Based CurrentSince Jun 1, 2018 Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456099200000",
    "number": "1396104048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 PEARSALL DR",
            "address_2": "APT 1B",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105523946",
            "telephone_number": "914-668-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 PEARSALL DR",
            "address_2": "APT 1B",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105523946",
            "telephone_number": "914-668-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDIBE",
        "first_name": "ABOULAYE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-22",
        "last_updated": "2016-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, NY

Sources for this page

Verify at the official NPI Registry.