Individual provider Active NPI

Michelle Brenseke

  • Registered Dietitian
  • New York, NY
National Provider Identifier
1720531387
Registry record updated Oct 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
008659 Issued in NY
Practice address
150 Essex St
New York, NY 10002-2301
Phone
(212) 477-1120
Fax
(212) 477-8957
NPI assigned
Aug 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 008659 NY Primary

Addresses

Primary practice location

150 Essex St
New York, NY 10002-2301

Mailing address

60 Madison Ave
5TH FL
New York, NY 10010-1600
Phone (212) 545-2400

Other identifiers 1

IdentifierTypeStateIssuer
00695941MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161025001224 NY Practitioner - Registered Dietitian Or Nutrition Professional 5395023428 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

132 E Main St
Bay Shore, NY 11706-8302
Phone (631) 647-2530

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
008659NYMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bronxcare Health System Dietitian, Registered CurrentSince Sep 1, 2021 Accepting new patients
Bronxcare Health System Current Accepting new patients
Bronxcare Health System CurrentSince Sep 1, 2021 Accepting new patients
North Shore-Lij Medical PC CurrentSince May 15, 2024 Accepting new patients
North Shore - Lij Medical PC CurrentSince May 15, 2024 Accepting new patients

Locations

132 E Main St
Bay Shore, NY 11706
Phone (516) 697-2042

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

9525 Queens Blvd
Fl 7
Rego Park, NY 11374
Phone (718) 575-9595

Networks

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

Organizations & group practices 5

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": "1470009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476144000000",
    "number": "1720531387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MADISON AVE",
            "address_2": "5TH FL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100101600",
            "telephone_number": "212-545-2400",
            "fax_number": "646-312-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 ESSEX ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100022301",
            "telephone_number": "212-477-1120",
            "fax_number": "212-477-8957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENSEKE",
        "first_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-01",
        "last_updated": "2016-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "008659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00695941",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.