Individual provider Active NPI

Mariel Frances Owen-Simon, CPNP

  • Pediatric Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1508533126
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
F383231 Issued in NY
Practice address
1065 Southern Blvd
Bronx, NY 10459-2417
Phone
(718) 589-2440
NPI assigned
Aug 23, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X F383231 NY Primary

Addresses

Primary practice location

1065 Southern Blvd
Bronx, NY 10459-2417

Mailing address

1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440

Other practice location 1

628 Tinton Ave
Bronx, NY 10455-3218
Phone (917) 737-8813

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
I20211027000122 NY Practitioner - Nurse Practitioner 7618365545 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F383231NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Urban Health Plan, Inc. CurrentSince Sep 17, 2021 Accepting new patients
Urban Health Plan, Inc. CurrentSince Sep 17, 2021 Accepting new patients

Locations

1515 Southern Blvd
#H
Bronx, NY 10460
Phone (718) 589-1600

866 E Tremont Ave
Bronx, NY 10460
Phone (347) 284-0595

1065 Southern Blvd
Bronx, NY 10459
Phone 71858924404222

890 Hunts Point Ave
Bronx, NY 10474
Phone (718) 589-2141

1515 Southern Blvd
Bronx, NY 10460
Phone (718) 589-1600

3209 3rd Ave
Bronx, NY 10451
Phone (347) 284-0203

960 Southern Blvd
Bronx, NY 10459
Phone (347) 331-6572

1967 Turnbull Ave
Bronx, NY 10473
Phone (718) 684-1320

271 E 138th St
Bronx, NY 10454
Phone (347) 407-7120

628 Tinton Ave
Bronx, NY 10455
Phone (718) 292-5478

3712 108th St
Corona, NY 11368
Phone (718) 639-4107

154 W 127th St
New York, NY 10027
Phone (212) 280-0804

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • 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": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1508533126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104592417",
            "telephone_number": "718-589-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104592417",
            "telephone_number": "718-589-2440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "628 Tinton Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104553218",
            "country_code": "US",
            "telephone_number": "917-737-8813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OWEN-SIMON",
        "first_name": "MARIEL",
        "middle_name": "FRANCES",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F383231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.