Individual provider Active NPI

Thamar Derisme Jean-Gilles, NP

  • Family Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1407514888
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
346321 Issued in NY
Practice address
466 Bay Ridge Ave
Brooklyn, NY 11220-5906
Phone
(347) 836-6923
NPI assigned
Dec 2, 2021
Last updated
Jan 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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 346321 NY Primary

Addresses

Primary practice location

466 Bay Ridge Ave
Brooklyn, NY 11220-5906

Mailing address

4 Paerdegat 7TH St
Brooklyn, NY 11236-4106
Phone (347) 404-3462

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
I20220107001344 NY Practitioner - Nurse Practitioner 2961892641 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
RJ Medical & Urgent Care, PLLC CurrentSince Dec 1, 2021 Accepting new patients

Locations

464 Bay Ridge Ave
Ste A
Brooklyn, NY 11220
Phone (718) 680-6006

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1798/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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": "1638403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1407514888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 PAERDEGAT 7TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112364106",
            "telephone_number": "347-404-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 BAY RIDGE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112205906",
            "telephone_number": "347-836-6923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEAN-GILLES",
        "first_name": "THAMAR",
        "middle_name": "DERISME",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-02",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "346321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.