Individual provider Active NPI

Rafael A. Tejada

  • Social Worker
  • New York, NY
National Provider Identifier
1487158416
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
102555 Issued in NY
Practice address
540 E 13TH St
New York, NY 10009
Phone
(212) 387-7400
NPI assigned
Mar 23, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 102555 NY Primary

Addresses

Primary practice location

540 E 13TH St
New York, NY 10009

Mailing address

12608 149TH Ave
South Ozone Park, NY 11420-3719
Phone (646) 220-0488

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230404001910 NY Practitioner - Clinical Social Worker 0143695114 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
102555NYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
New York City Health and Hospitals Corporation CurrentSince Dec 29, 2022 Accepting new patients
New York City Health and Hospitals Corporation CurrentSince Dec 29, 2022 Accepting new patients

Locations

50 Water St
Fl 3
New York, NY 10004

227 Madison St
New York, NY 10002
Phone (212) 238-7000

540 E 13th St
New York, NY 10009
Phone (212) 387-7400

Networks

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

Organizations & group practices 2

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": "1521763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531353600000",
    "number": "1487158416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12608 149TH AVE",
            "city": "SOUTH OZONE PARK",
            "state": "NY",
            "postal_code": "114203719",
            "telephone_number": "646-220-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 E 13TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10009",
            "telephone_number": "212-387-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEJADA",
        "first_name": "RAFAEL",
        "middle_name": "A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-23",
        "last_updated": "2018-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "102555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.