Individual provider Active NPI

Eduardo Santiago Antonio Jr., PA

  • Emergency Medicine Physician
  • New York, NY
National Provider Identifier
1427140805
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0004771 Issued in NY
Practice address
1879 Madison Ave
New York, NY 10035-2709
Phone
(212) 423-4262
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0004771 NY Primary

Addresses

Primary practice location

1879 Madison Ave
New York, NY 10035-2709

Mailing address

80 Charlotte PL
Hartsdale, NY 10530-2602
Phone (914) 625-4568

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
I20070604000746 NY Practitioner - Physician Assistant 3274631908 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
004771NYMDAcupuncturist
0004771NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Jun 20, 2016 Accepting new patients
Trustees of Columbia University in the City of New York Emergency Medicine CurrentSince Jun 20, 2016 Accepting new patients
Montefiore Medical Center Emergency Medicine Past Accepting new patients
Madison Avenue Emergency Medicine PC Emergency Medicine Past Accepting new patients

Locations

1980 Crompond Rd
Cortlandt Mnr, NY 10567
Phone (914) 734-3600

12 N 7th Ave
Mount Vernon, NY 10550
Phone (914) 361-6511

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 1137
New York, NY 10032
Phone (212) 305-2575

Networks

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

Interoperability endpoints

  • Direct secure messaging: esa9013@direct.nyp.org
  • 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 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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427140805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 CHARLOTTE PL",
            "city": "HARTSDALE",
            "state": "NY",
            "postal_code": "105302602",
            "telephone_number": "914-625-4568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1879 MADISON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100352709",
            "telephone_number": "212-423-4262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONIO",
        "first_name": "EDUARDO",
        "middle_name": "SANTIAGO",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "0004771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.