NPIMap

Individual provider Active NPI

Mitra Rezvani, M.D.

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1518950385
Registry record updated Aug 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
002066 Issued in NY
Practice address
515 Audubon Avenue
Isabella Geriatric Center
New York, NY 10040-3403
Phone
(212) 342-9495
NPI assigned
Aug 26, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 002066 NY Primary

Addresses

Primary practice location

515 Audubon Avenue
Isabella Geriatric Center
New York, NY 10040-3403

Mailing address

64 Birch Rd
Briarcliff Manor, NY 10510
Phone (917) 873-7995

Other identifiers 1

IdentifierTypeStateIssuer
02579913MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040519001589 NY Practitioner - HospitalistPractitioner - Internal Medicine 5890786784 Reassigns benefits to 3 organizations
Practice locations: New York, NY

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Woods Rd
Valhalla, NY 10595-1530

241 N Rd
Poughkeepsie, NY 12601-1154
Phone (845) 483-5000

95 Grasslands Rd
Valhalla, NY 10595-1652
Phone (914) 493-6940

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
002066NYMDArt Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Internal Medicine CurrentSince Mar 1, 2020 Accepting new patients
Northern Westchester Hospital Association Internal Medicine CurrentSince Aug 25, 2018 Accepting new patients
Northern Westchester Hospital Association Current Accepting new patients
Northern Westchester Hospital Association CurrentSince Aug 25, 2018 Accepting new patients
Westchester Medical Center Advanced Physician Services PC CurrentSince Oct 1, 2019 Accepting new patients
Westchester Medical Center Advanced Physician Services, PC CurrentSince Oct 1, 2019 Accepting new patients
Mskcc Radiology Group Past Accepting new patients
Westchester County Health Care Corporation Past Accepting new patients
St Lukes Roosevelt Community Care Internal Medicine Past Accepting new patients

Locations

400 E Main St
Mount Kisco, NY 10549
Phone (914) 666-1200

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

300 Community Dr
Plandome, NY 11030

95 Grasslands Rd
Valhalla, NY 10595
Phone (914) 493-2961

Networks

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

Organizations & group practices 9

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.

Hospital & facility affiliations 1

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": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1518950385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 BIRCH RD",
            "city": "BRIARCLIFF MANOR",
            "state": "NY",
            "postal_code": "10510",
            "telephone_number": "917-873-7995",
            "fax_number": "917-873-7995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 AUDUBON AVENUE",
            "address_2": "ISABELLA GERIATRIC CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100403403",
            "telephone_number": "212-342-9495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZVANI",
        "first_name": "MITRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-26",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "002066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02579913",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.