Individual provider Active NPI

Maryann Lopez, NP

  • Family Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1649386186
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
332491 Issued in NY
Practice address
745 64TH St
Brooklyn, NY 11220-4745
Phone
(718) 765-2576
Fax
(718) 635-5962
NPI assigned
Aug 21, 2006
Last updated
Jul 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 332491 NY Primary

Addresses

Primary practice location

745 64TH St
Brooklyn, NY 11220-4745

Mailing address

745 64TH St
Brooklyn, NY 11220-4745
Phone (718) 765-2576

Other practice location 1

475 Seaview Ave
Staten Island, NY 10305-3436
Phone (718) 226-6134

Other identifiers 1

IdentifierTypeStateIssuer
02710649MedicaidNY

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
I20061229000305 NY Practitioner - Nurse Practitioner 9436159241 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MMC Division of Breast SurgeryGroup PAC ID 0244297240, 6 clinicians

Practice addresses (Care Compare)

6300 8TH Ave
Brooklyn, NY 11220-4718
Phone (718) 765-2600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
332491NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Maimonides Faculty Practice Plan CurrentSince Dec 3, 2018 Accepting new patients
Maimonides Medical Center Current Accepting new patients
MMC Division of Breast Surgery CurrentSince Mar 1, 2021 Accepting new patients

Locations

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

6300 8th Ave
Brooklyn, NY 11220
Phone (718) 765-2600

745 64th St
Brooklyn, NY 11220
Phone (718) 765-2570

Networks

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

Interoperability endpoints

  • Direct secure messaging: maryann.lopez.p1@direct.mmc.nextgenshare.com
  • Direct secure messaging: maryannlopez@mai.allscriptsdirect.net

Organizations & group practices 3

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 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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1649386186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 64TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112204745",
            "telephone_number": "718-765-2576",
            "fax_number": "718-635-5962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 64TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112204745",
            "telephone_number": "718-765-2576",
            "fax_number": "718-635-5962"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Seaview Ave",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103053436",
            "country_code": "US",
            "telephone_number": "718-226-6134",
            "fax_number": "718-226-6133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "MARYANN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2022-07-26",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "332491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02710649",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.