Individual provider Active NPI

Matthew Mekhail

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1588295141
Registry record updated May 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
309404 Issued in NY
Practice address
622 W 168TH St
New York, NY 10032-3720
Phone
(212) 305-9564
Fax
(212) 342-3591
NPI assigned
Jan 31, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 309404 NY
Adult Health Nurse Practitioner 363LA2200X 309404 NY Primary

Addresses

Primary practice location

622 W 168TH St
New York, NY 10032-3720

Mailing address

630 W 168TH St # 4
New York, NY 10032-3725
Phone (212) 305-9564

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
I20200612000313 NY Practitioner - Nurse Practitioner 5799107124 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
309404NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Apr 12, 2020 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Apr 12, 2020 Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients
Trustees of Columbia University in the City of New York Past Accepting new patients

Locations

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

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

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

Interoperability endpoints

  • Direct secure messaging: mam9830@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • Direct secure messaging: mmekhail1902401@nychhc.direct-ci.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589414400000",
    "number": "1588295141",
    "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": "212-305-9564",
            "fax_number": "212-342-3591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-9564",
            "fax_number": "212-342-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEKHAIL",
        "first_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-31",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "309404",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "309404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.