Individual provider Active NPI

Kobina Dwira, PA

  • Physician Assistant
  • Carmel, NY
National Provider Identifier
1407165780
Registry record updated Sep 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014166 Issued in NY
Practice address
75 Seminary Hill Rd
Carmel, NY 10512-1921
Phone
(845) 225-3400
Fax
(845) 704-6178
NPI assigned
Oct 4, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2014

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 014166 NY Primary

Addresses

Primary practice location

75 Seminary Hill Rd
Carmel, NY 10512-1921

Mailing address

23 E 3Rd St Apt D23
Mount Vernon, NY 10550-3980
Phone (646) 713-7817

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
I20110221000076 NY Practitioner - Physician Assistant 5799966008 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
014166NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bronxcare Health System CurrentSince Aug 15, 2014 Accepting new patients
Bronxcare Health System Physician Assistant CurrentSince Aug 15, 2014 Accepting new patients
Arms Acres Inc Past Accepting new patients
Arms Acres Inc Past Accepting new patients

Locations

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

Networks

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

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409875200000",
    "number": "1407165780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 E 3RD ST APT D23",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105503980",
            "telephone_number": "646-713-7817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SEMINARY HILL RD",
            "city": "CARMEL",
            "state": "NY",
            "postal_code": "105121921",
            "telephone_number": "845-225-3400",
            "fax_number": "845-704-6178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWIRA",
        "first_name": "KOBINA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-04",
        "last_updated": "2014-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, NY

Sources for this page

Verify at the official NPI Registry.