Active NPI
Jimmie Overstreet
- Specialist
- New York, NY
National Provider Identifier
1508253733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 497489041
- Practice address
- 236 2ND Ave
Suite 401
New York, NY 10003-2704 - Phone
- (212) 683-8905
- Fax
- (212) 683-8906
- NPI assigned
- Apr 27, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 497489041 | NY | Primary |
Addresses
Primary practice location
236 2ND Ave
Suite 401
New York, NY 10003-2704
Mailing address
9010 149TH St
Apt 1B
Jamaica, NY 11435-3956
Phone (347) 770-1106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 497489041 | NY | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Functional Life Achievement. Ink. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Early Intervention Provider Agency
- New York, NY
- NPI 1902161649
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430092800000",
"number": "1508253733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9010 149TH ST",
"address_2": "APT 1B",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114353956",
"telephone_number": "347-770-1106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "236 2ND AVE",
"address_2": "SUITE 401",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100032704",
"telephone_number": "212-683-8905",
"fax_number": "212-683-8906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OVERSTREET",
"first_name": "JIMMIE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-27",
"last_updated": "2015-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "497489041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.