Individual provider Active NPI

Regina Wagner Janicik, MD

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1629019476
Registry record updated Dec 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
214138 Issued in NY
Practice address
80 Maiden LN RM 1901
New York, NY 10038-4717
Phone
(212) 379-6480
NPI assigned
Jun 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2019

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 214138 NY Primary

Addresses

Primary practice location

80 Maiden LN RM 1901
New York, NY 10038-4717

Mailing address

80 Maiden LN RM 1902
New York, NY 10038-4773
Phone (212) 379-6480

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060628000252 NY Practitioner - Internal Medicine 0840202263 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Chicago, Pritzker School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Downtown Primary Care LLPGroup PAC ID 6002706116, 3 clinicians

Practice addresses (Care Compare)

80 Maiden LN
RM 1902
New York, NY 10038-4773
Phone (212) 379-6480

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
214138NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Downtown Primary Care LLP Internal Medicine CurrentSince Sep 1, 2002 Accepting new patients

Locations

418 Lafayette St
Apt 351
New York, NY 10003
Phone (212) 992-9190

80 Maiden Ln
Rm 1901
New York, NY 10038
Phone (212) 379-6480

80 Maiden Ln
Rm 1902
New York, NY 10038
Phone (212) 379-6480

Interoperability endpoints

  • Direct secure messaging: rjanicik43713@nyumc.direct-ci.com

Organizations & group practices 1

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 7

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": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576713600000",
    "number": "1629019476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 MAIDEN LN RM 1902",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100384773",
            "telephone_number": "212-379-6480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 MAIDEN LN RM 1901",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100384717",
            "telephone_number": "212-379-6480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANICIK",
        "first_name": "REGINA",
        "middle_name": "WAGNER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "214138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.