Sandra B Mampouya, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

009842 Issued in NY

Practice address

21468 Whitehall Ter
Queens Village, NY 11427-1829

Phone

(718) 740-0253

NPI assigned

Sep 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles (1 of 5)

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: sandramampouya@nslijmedgr.allscriptsdirect.net
• Direct secure messaging: sbm9004@direct.nyp.org

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment Care Compare group
• New York Community Hospital of Brooklyn Inc

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1215030697
  Medicare reassignment NPD
• New York Community Hospital of Brooklyn Inc

  • Psychiatric Hospital Unit
  • Brooklyn, NY
  • NPI 1508377334
  Medicare reassignment

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427159367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21468 WHITEHALL TER",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114271829",
            "telephone_number": "718-740-0253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21468 WHITEHALL TER",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114271829",
            "telephone_number": "718-740-0253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMPOUYA",
        "first_name": "SANDRA",
        "middle_name": "B",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "009842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00246075",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenny Maitre-Baptiste
• Irina Makdulin
• Rosina Makombese
• Joseph Maldonado
• Ashly Mammen, SLP
• Alexandra Manderson, LMSW
• Amritha Mangalat, MD
• Patricia Ann Manhart
• Sosamma K Mani
• Irene E Maningas, PHARM D

• Physician Assistant in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.