Individual provider Active NPI

Johanis Thamar Patsikos, NURSE PRACTITIONER

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1518370055
Registry record updated May 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F308049 Issued in NY
Practice address
161 Fort Washington Ave
New York, NY 10032-3729
Phone
(212) 305-7340
Fax
(212) 305-6891
NPI assigned
Jun 3, 2014
Last updated
May 9, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F308049-1 NY
Adult Health Nurse Practitioner 363LA2200X F308049 NY Primary
Registered Nurse 163W00000X 677151 NY

Addresses

Primary practice location

161 Fort Washington Ave
New York, NY 10032-3729

Mailing address

630 W 168TH St # 4
New York, NY 10032-3725
Phone (212) 305-7340

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
I20190318001328 NY Practitioner - Nurse Practitioner 9335489905 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Columbia University College of Physicians and Surgeons, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

622 W 168TH St
New York, NY 10032-3720
Phone (646) 317-7111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
677151NYMDRegistered Nurse
F308049-1NYMDNurse Practitioner
F308049NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Feb 23, 2019 Accepting new patients
Trustees of Columbia University in the City of New York Nurse Practitioner Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jan 26, 2019 Accepting new patients
Trustees of Columbia University in the City of New York Nurse Practitioner CurrentSince Jan 26, 2019 Accepting new patients

Locations

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

622 W 168th St
Ph 3303
New York, NY 10032
Phone (212) 305-2654

630 W 168th St
#4
New York, NY 10032
Phone (212) 305-6387

Networks

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

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: jog9223@direct.nyp.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557360000000",
    "number": "1518370055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 W 168TH ST # 4",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323725",
            "telephone_number": "212-305-7340",
            "fax_number": "212-305-6891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 FORT WASHINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323729",
            "telephone_number": "212-305-7340",
            "fax_number": "212-305-6891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATSIKOS",
        "first_name": "JOHANIS",
        "middle_name": "THAMAR",
        "credential": "NURSE  PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-03",
        "last_updated": "2019-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F308049-1",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F308049",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "677151",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.