Individual provider Active NPI

Nataliya Pontone

  • Psychiatric/Mental Health Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1508147208
Registry record updated Jan 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F404553-01 Issued in NY
Practice address
200 Corbin PL Apt L1
Brooklyn, NY 11235-4932
Phone
(718) 238-2285
NPI assigned
Sep 8, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 643262-1 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F404553-01 NY Primary

Addresses

Primary practice location

200 Corbin PL Apt L1
Brooklyn, NY 11235-4932

Mailing address

2170 Brigham St Apt 4C
Brooklyn, NY 11229-5640
Phone (718) 269-8152

Other identifiers 1

IdentifierTypeStateIssuer
02386450MedicaidNY

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
I20230125002292 NY Practitioner - Nurse Practitioner 3173994316 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Revived Soul Medical PCGroup PAC ID 0749466266, 15 clinicians

Practice addresses (Care Compare)

1329 E 17TH St
Brooklyn, NY 11230-6052
Phone (718) 382-5060

Merit-based Incentive Payment System (MIPS)

Final score
99.08 of 100Reported as group
Quality
85
Improvement activities
40
Cost
83.71

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
643262-1NYMDRegistered Nurse
F404553-01NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles (2 of 6)

OrganizationSpecialtyStatusNew patients
Revived Soul Medical PC CurrentSince May 1, 2023 Accepting new patients
Helpful Hand Agency Inc Past Accepting new patients

Locations

307 Ocean View Ave
Brooklyn, NY 11235
Phone (718) 743-5555

Networks

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

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": "1315440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1508147208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2170 BRIGHAM ST APT 4C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112295640",
            "telephone_number": "718-269-8152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CORBIN PL APT L1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112354932",
            "telephone_number": "718-238-2285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONTONE",
        "first_name": "NATALIYA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-08",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "643262-1",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F404553-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02386450",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.