Individual provider Active NPI

Tiffany Lauren Lawson, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1699350587
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F403428-01 Issued in NY
Practice address
1329 E 17TH St
Brooklyn, NY 11230-6052
Phone
(718) 382-5060
NPI assigned
Mar 12, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F403428-01 NY Primary

Addresses

Primary practice location

1329 E 17TH St
Brooklyn, NY 11230-6052

Mailing address

1329 E 17TH St
Brooklyn, NY 11230-6052
Phone (718) 382-5060

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://ehr.icanotes.com/ Other

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
I20210603002490 NY Practitioner - Nurse Practitioner 4587063086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Revived Soul Medical PCGroup PAC ID 0749466266, 15 clinicians

Practice addresses (Care Compare)

1329 E 17TH St
Brooklyn, NY 11230-6052
Phone (718) 382-5060

Merit-based Incentive Payment System (MIPS)

Final score
99.08 of 100Reported as group
Quality
85
Improvement activities
40
Cost
83.71

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F403428-01NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Revived Soul Medical PC CurrentSince May 1, 2021 Accepting new patients

Locations

307 Ocean View Ave
Brooklyn, NY 11235
Phone (718) 743-5555

Networks

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1615507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1699350587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 E 17TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112306052",
            "telephone_number": "718-382-5060",
            "fax_number": "718-382-5905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1329 E 17TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112306052",
            "telephone_number": "718-382-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWSON",
        "first_name": "TIFFANY",
        "middle_name": "LAUREN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-12",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F403428-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://ehr.icanotes.com/",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Brooklyn",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1329 E 17th St",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112306052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.