Individual provider Active NPI

Jack Kevin Vassar, PA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1750661633
Registry record updated Nov 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014815 Issued in NY
Practice address
425 W 59TH St
Suite 3a
New York, NY 10019-8022
Phone
(212) 241-3919
NPI assigned
Aug 23, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2014

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 014815 NY Primary

Addresses

Primary practice location

425 W 59TH St
Suite 3a
New York, NY 10019-8022

Mailing address

425 W 59TH St
Suite 3a
New York, NY 10019-8022

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
I20210311001546 NY Practitioner - Physician Assistant 6305010554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

425 W 59TH St
Urology Dept of Mount Sinai
New York, NY 10019-8022
Phone (212) 523-3340

5 E 98TH St
New York, NY 10029-6501
Phone (212) 241-0045

One Gustave L Levy Place
New York, NY 10029-6574
Phone (212) 241-0045

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
014815NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 1, 2021 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 1, 2021 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

150 E 42nd St
New York, NY 10017
Phone (212) 661-8139

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

625 Madison Ave
Fl 2
New York, NY 10022
Phone (212) 241-4812

10 Union Sq E
Ste 3A
New York, NY 10003
Phone (212) 844-8100

1090 Amsterdam Ave
Ste 7G
New York, NY 10025
Phone (212) 362-7160

425 W 59th St
Ste 4F
New York, NY 10019
Phone (212) 241-1272

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

425 W 59th St
Ste 3A
New York, NY 10019
Phone (212) 523-7016

5 E 98th St
Fl 6
New York, NY 10029
Phone (212) 241-2221

Networks

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

Organizations & group practices 4

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 6

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": "1314057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415836800000",
    "number": "1750661633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W 59TH ST",
            "address_2": "SUITE 3A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100198022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W 59TH ST",
            "address_2": "SUITE 3A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100198022",
            "telephone_number": "212-241-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASSAR",
        "first_name": "JACK",
        "middle_name": "KEVIN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-23",
        "last_updated": "2014-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.