Individual provider Active NPI

Xiaotong Zhang

  • Adult Health Nurse Practitioner
  • Delevan, NY
National Provider Identifier
1578315230
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F311764 Issued in NY
Practice address
4676 Gooseneck Rd
Delevan, NY 14042-9454
Phone
(347) 876-1758
NPI assigned
Apr 4, 2024
Last updated
Oct 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F311764 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

4676 Gooseneck Rd
Delevan, NY 14042-9454

Mailing address

4676 Gooseneck Rd
Delevan, NY 14042-9454
Phone (347) 876-1758

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
I20240913000754 NY Practitioner - Nurse Practitioner 5395285696 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Mobile Medical Care PCGroup PAC ID 8426575325, 97 clinicians
Mobile Physician Services PLLCGroup PAC ID 8325360290, 104 clinicians

Practice addresses (Care Compare)

Buffalo, NY 14202
Phone (716) 893-1010

40 La Riviere Dr
Suite 201
Buffalo, NY 14202-4036
Phone 7168931010210

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F311764NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
JDS Medical Services PC CurrentSince Jan 17, 2026 Accepting new patients
Medical Director Services PC CurrentSince Aug 6, 2024 Accepting new patients

Locations

50 Sheffield Ave
Brooklyn, NY 11207
Phone (718) 250-8789

831 Bedford Ave
Brooklyn, NY 11205

1311 Virginia St
Far Rockaway, NY 11691
Phone (718) 327-2908

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 2

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": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1578315230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4676 GOOSENECK RD",
            "city": "DELEVAN",
            "state": "NY",
            "postal_code": "140429454",
            "telephone_number": "347-876-1758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4676 GOOSENECK RD",
            "city": "DELEVAN",
            "state": "NY",
            "postal_code": "140429454",
            "telephone_number": "347-876-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZHANG",
        "first_name": "XIAOTONG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F311764",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delevan, NY

Sources for this page

Verify at the official NPI Registry.