Individual provider Active NPI

Vanessa A Menjivar

  • Psychiatric/Mental Health Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1659892495
Registry record updated Jun 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F402398-1 Issued in NY
Practice address
750 Astor Ave
Bronx, NY 10467
Phone
(718) 882-5000
NPI assigned
Jul 2, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 22-719661 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F402398-1 NY Primary

Addresses

Primary practice location

750 Astor Ave
Bronx, NY 10467

Mailing address

1019 Southern Blvd Apt 3D
Bronx, NY 10459-3499

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
I20190607001470 NY Practitioner - Nurse Practitioner 4587997465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

9777 Queens Blvd
Rego Park, NY 11374-3335
Phone (718) 896-9090

Merit-based Incentive Payment System (MIPS)

Final score
87.65 of 100Reported as group
Quality
71.56
Promoting interoperability
74
Improvement activities
40
Cost
87.55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22-719661NYMDRegistered Nurse
F402398-1NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jewish Board of Family and Children'S Services, Inc. Psychiatric/Mental Health CurrentSince Mar 31, 2019 Accepting new patients
Jewish Board of Family & Childrens Services Inc CurrentSince Mar 31, 2019 Accepting new patients

Locations

750 Astor Ave
Bronx, NY 10467
Phone (718) 882-5000

1273 53rd St
Brooklyn, NY 11219
Phone (718) 435-5700

9777 Queens Blvd
Rego Park, NY 11374
Phone (718) 275-9300

Interoperability endpoints

  • Direct secure messaging: sohomd.vanessamenjivar@157389.advancedmd-direct.com

Organizations & group practices 2

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": "1498953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1659892495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 SOUTHERN BLVD APT 3D",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104593499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 ASTOR AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10467",
            "telephone_number": "718-882-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENJIVAR",
        "first_name": "VANESSA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-02",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "22-719661",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402398-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.