Active NPI
Medcare, LLC
- Family Medicine Physician
- Brooklyn, NY
National Provider Identifier
1508993650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 219313
- Legal business name
- MEDCARE, LLC
- Practice address
- 468 Lafayette Ave
Brooklyn, NY 11205-4809 - Phone
- (718) 399-6234
- Fax
- (718) 399-3516
- NPI assigned
- Feb 27, 2007
- Organization subpart
- No
Authorized official
NPPES NPI Registry- Name
- Sofiya Keisserman
- Title
- Owner/Administrator
- Phone
- (718) 399-6234
Practitioners 54
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Brooklyn, NY
- NPI 1669839031
NY
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D1069834 | Medcare LLC | Certificate of waiver | Mar 26, 2027 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070511000578 | NY | Part B Supplier - Clinic/Group Practice | 9537265541 |
Receives reassigned benefits from 31 practitioners Practice locations: Brooklyn, NY; Monsey, NY; Pomona, NY |
National Provider Directory
National Provider DirectoryLocations
468 Lafayette Ave
Brooklyn, NY 11205
Phone (718) 399-6234
75 Route 59
Monsey, NY 10952
Phone (845) 356-2273
217 Beach 95th St
Rockaway Beach, NY 11693
Phone (314) 727-7004
Specialties & licenses 8
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV006926 | NY | |
| Family Medicine Physician | 207Q00000X | 219313 | NY | Primary |
| Internal Medicine Physician | 207R00000X | 218384 | NY | |
| Cardiovascular Disease Physician | 207RC0000X | 127692 | NY | |
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 174588 | NY | |
| Obstetrics & Gynecology Physician | 207V00000X | 233517 | NY | |
| Podiatrist | 213E00000X | N006039 | NY | |
| Physical Therapist | 225100000X | 026957 | NY |
Addresses
NPPES NPI RegistryPrimary practice location
468 Lafayette Ave
Brooklyn, NY 11205-4809
Mailing address
468 Lafayette Ave
Brooklyn, NY 11205-4809
Phone (718) 399-6234
Other identifiers 1
NPPES NPI Registry| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03010506 | Medicaid | NY |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 7, 2015.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1428364800000",
"number": "1508993650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "468 LAFAYETTE AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112054809",
"telephone_number": "718-399-6234",
"fax_number": "718-399-3516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "468 LAFAYETTE AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112054809",
"telephone_number": "718-399-6234",
"fax_number": "718-399-3516"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDCARE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-27",
"last_updated": "2015-04-07",
"status": "A",
"authorized_official_last_name": "KEISSERMAN",
"authorized_official_first_name": "SOFIYA",
"authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
"authorized_official_telephone_number": "718-399-6234"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Optometrist",
"state": "NY",
"license": "TUV006926",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "NY",
"license": "219313",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "NY",
"license": "218384",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NY",
"license": "127692",
"primary": false
},
{
"code": "207RE0101X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "NY",
"license": "174588",
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": "NY",
"license": "233517",
"primary": false
},
{
"code": "213E00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Podiatrist",
"state": "NY",
"license": "N006039",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "NY",
"license": "026957",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03010506",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.