Individual provider Active NPI

Mira Lena Bhattacharya, PA

  • Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1487488458
Registry record updated Apr 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
033666 Issued in NY
Practice address
569 Senator St
Brooklyn, NY 11220-5411
Phone
(646) 330-7123
NPI assigned
Aug 30, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 033666 NY Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

569 Senator St
Brooklyn, NY 11220-5411

Mailing address

569 Senator St
Brooklyn, NY 11220-5411

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
I20260218002041 NY Practitioner - Physician Assistant 1557850112 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kings Medical Family Practice, P.C.Group PAC ID 4082989645, 18 clinicians
My Medical PCGroup PAC ID 0143610600, 93 clinicians

Practice addresses (Care Compare)

1295 Broadway
Brooklyn, NY 11221-2973
Phone (718) 682-3903

2830 Pitkin Ave
Brooklyn, NY 11208-3220
Phone (718) 235-0900

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
033666NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ag Urgent Care, P.C. Multi-Specialty CurrentSince Feb 1, 2026 Accepting new patients
Py Medical PLLC Multi-Specialty CurrentSince Feb 2, 2026 Accepting new patients
Kings Medical Family Practice PC Multi-Specialty CurrentSince Feb 1, 2026 Accepting new patients

Locations

1295 Broadway
Brooklyn, NY 11221
Phone (718) 682-3903

1576 Flatbush Ave
Ste 1
Brooklyn, NY 11210

2830 Pitkin Ave
Brooklyn, NY 11208
Phone (347) 420-8295

8008 45th Ave
Flushing, NY 11373
Phone (718) 373-0777

130 Lake Ave S
Nesconset, NY 11767
Phone (631) 636-0620

822 Cedar Ave
Niagara Falls, NY 14301
Phone (716) 272-1207

140 Meisner Ave
Staten Island, NY 10306
Phone (718) 979-1800

Networks

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

Interoperability endpoints

  • Direct secure messaging: mbhattacharya7547289@nychhc.direct-ci.com

Organizations & group practices 4

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": "1724976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743897600000",
    "number": "1487488458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "569 SENATOR ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112205411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "569 SENATOR ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112205411",
            "telephone_number": "646-330-7123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHATTACHARYA",
        "first_name": "MIRA",
        "middle_name": "LENA",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-30",
        "last_updated": "2025-04-06",
        "certification_date": "2025-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "033666",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.