Individual provider Active NPI

Brandon Scott Mogrovejo, MD

  • Pediatrics Physician
  • Bronxville, NY
National Provider Identifier
1437787223
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
315280 Issued in NY
Practice address
55 Palmer Ave
Bronxville, NY 10708-3403
Phone
(914) 787-1000
NPI assigned
Mar 29, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 315280 NY Primary

Addresses

Primary practice location

55 Palmer Ave
Bronxville, NY 10708-3403

Mailing address

55 Palmer Ave
Bronxville, NY 10708-3403
Phone (914) 787-1000

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/ Health Information Exchange (HIE)
Direct Messaging Address bsm7002@direct.nyp.org Direct

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230915000853 NY Practitioner - Pediatric Medicine 6204290810 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
315280NYMDPediatrics Physician

Practice roles (5 of 9)

OrganizationSpecialtyStatusNew patients
Lawrence Medical Associates, PC CurrentSince Oct 1, 2023 Accepting new patients
Lawrence Medical Associates, PC CurrentSince Oct 1, 2023 Accepting new patients
Trustees of Columbia University in the City of New York Pediatrics Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Aug 16, 2023 Accepting new patients
The New York and Presbyterian Hospital Past Accepting new patients

Locations

400 Kelby St
Fl 9
Fort Lee, NJ 07024

55 Palmer Ave
Bronxville, NY 10708
Phone (914) 787-3136

685 White Plains Rd
Lowr
Eastchester, NY 10709
Phone (914) 787-4100

685 White Plains Rd
Fl 2
Eastchester, NY 10709
Phone (914) 787-4100

3959 Broadway
New York, NY 10032
Phone (212) 304-7297

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

Networks

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

Interoperability endpoints

  • Direct secure messaging: bsm7002@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 6

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": "1585440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1437787223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 PALMER AVE",
            "city": "BRONXVILLE",
            "state": "NY",
            "postal_code": "107083403",
            "telephone_number": "914-787-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 PALMER AVE",
            "city": "BRONXVILLE",
            "state": "NY",
            "postal_code": "107083403",
            "telephone_number": "914-787-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGROVEJO",
        "first_name": "BRANDON",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-29",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "315280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "55 Palmer Ave",
            "city": "Bronxville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "107083403",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "55 Palmer Ave",
            "city": "Bronxville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "107083403",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bsm7002@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Address",
            "address_1": "55 Palmer Ave",
            "city": "Bronxville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "107083403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bronxville, NY

Sources for this page

Verify at the official NPI Registry.