Individual provider Active NPI

Moomitu Kashem, PA

  • Medical Physician Assistant
  • Jamaica, NY
National Provider Identifier
1447941158
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
029930-01 Issued in NY
Practice address
15536 116TH Dr
Jamaica, NY 11434-1514
Phone
(347) 283-3623
NPI assigned
May 15, 2023
Last updated
May 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 029930-01 NY Primary

Addresses

Primary practice location

15536 116TH Dr
Jamaica, NY 11434-1514

Mailing address

15536 116TH Dr
Jamaica, NY 11434-1514
Phone (347) 283-3623

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
I20230606001184 NY Practitioner - Physician Assistant 1759748882 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
029930-01NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jamaica Hospital CurrentSince Aug 1, 2024 Accepting new patients
Jamaica Hospital CurrentSince Aug 1, 2024 Accepting new patients

Locations

80 Marcus Dr
Melville, NY 11747
Phone (631) 391-7889

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

Networks

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

Organizations & group practices 3

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": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1447941158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15536 116TH DR",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114341514",
            "telephone_number": "347-283-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15536 116TH DR",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114341514",
            "telephone_number": "347-283-3623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASHEM",
        "first_name": "MOOMITU",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "029930-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.