Marissa Pedro, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

324653 Issued in NY

Practice address

55 E 34TH St FL 5
New York, NY 10016-4337

Phone

(212) 252-6005

NPI assigned

Jun 26, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Lake Erie College of Osteopathic Medicine, Erie, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Networks

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

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.

• Icahn School of Medicine at Mount Sinai

  • Internal Medicine Physician
  • New York, NY
  • NPI 1568841930
  Medicare reassignment Care Compare group NPD
• Bronxcare Health System

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1245390855
  Medicare reassignment NPD
• Bronxcare Health System

  • Methadone Clinic
  • Bronx, NY
  • NPI 1801428222
  NPD
• Icahn School of Medicine at Mount Sinai

  • Eyewear Supplier
  • New York, NY
  • NPI 1760227466
  NPD

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

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1518528991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E 34TH ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100164337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 E 34TH ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100164337",
            "telephone_number": "212-252-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDRO",
        "first_name": "MARISSA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-26",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "324653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adriana Marcela Pedraza Bermeo, MD
• Madeline G. Pedraza, C.A.S.A.C.
• Margo Pedraza
• Vincent M Pedre, M.D.
• Chrisie Yvette Pedrena, MSED
• Nicole Pedroarena
• Inez Pedroso
• Maura E. Pedroso, M.D.
• Domenic Joseph Pedulla, MD
• Jennifer Lynn Pedulla, FNP

• Internal Medicine Physician in New York, NY
• Providers in New York, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.

Verify at the official NPI Registry.