NPIMap

Individual provider Active NPI

Elizabeth Wist, PA

  • Physician Assistant
  • New York, NY
National Provider Identifier
1720226863
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
011195 Issued in NY
Practice address
177 Fort Washington Avenue
MHB 7GN-435
New York, NY 10032
Phone
(212) 305-2633
NPI assigned
Jan 28, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 011195 NY Primary

Addresses

Primary practice location

177 Fort Washington Avenue
MHB 7GN-435
New York, NY 10032

Mailing address

941 Garden St Apt 3
Hoboken, NJ 07030-4299
Phone (516) 383-5155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090514000354 NY Practitioner - Physician Assistant 3870642218 Reassigns benefits to 1 organization
I20231226000568 NJ Practitioner - Physician Assistant 3870642218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Practice Associates Medical GroupGroup PAC ID 5890703177, 1,412 clinicians

Practice addresses (Care Compare)

100 Madison Ave
Morristown, NJ 07960-6136
Phone (973) 971-5596

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
011195NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York Physician Assistant CurrentSince Oct 24, 2020 Accepting new patients
Trustees of Columbia University in the Department of Otolaryngology PastSince Nov 8, 2020 Accepting new patients
St. Vincent'S Emergency Services PC Past Accepting new patients
Trustees of Columbia University in the City of New York Past Accepting new patients
Metro Emergency Medical Association PLLC Past Accepting new patients
Trustees of Columbia University in the City of New York Past Accepting new patients

Locations

177 Fort Washington Ave
#7
New York, NY 10032
Phone (212) 305-2633

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

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 7

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 5

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": "1233100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1720226863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 GARDEN ST APT 3",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070304299",
            "telephone_number": "516-383-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 FORT WASHINGTON AVENUE",
            "address_2": "MHB 7GN-435",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10032",
            "telephone_number": "212-305-2633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIST",
        "first_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-28",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.