Individual provider Active NPI

Jonathan Wassermann, MD

  • Emergency Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1760477418
Registry record updated Mar 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
233336-1 Issued in NY
Practice address
445 Lenox Rd
Brooklyn, NY 11203-2017
Phone
(718) 245-4790
NPI assigned
Sep 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 233336-1 NY Primary

Addresses

Primary practice location

445 Lenox Rd
Brooklyn, NY 11203-2017

Mailing address

445 Lenox Rd
Box 1262
Brooklyn, NY 11203-2017
Phone (718) 245-4790

Other identifiers 1

IdentifierTypeStateIssuer
02602431MedicaidNY

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041129000680 NY Practitioner - Emergency Medicine 9133184443 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Chicago College of Medicine and Surgery, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interfaith Emergency Medicine PCGroup PAC ID 7012186638, 32 clinicians

Practice addresses (Care Compare)

1545 Atlantic Ave
Brooklyn, NY 11213-1122
Phone (718) 613-4000

Hospital & facility affiliations

  • Brookdale Hospital Medical Center Hospital, Brooklyn, NY, CCN 330233

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
233336-1NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fpa Hospital Based Current Accepting new patients
Fpa Hospital Based Emergency Medicine CurrentSince Aug 1, 2014 Accepting new patients
North Shore - Lij Medical PC CurrentSince Feb 21, 2019 Accepting new patients
Fpa Hospital Based CurrentSince Aug 1, 2014 Accepting new patients
Interfaith Emergency Medicine, P.C. Emergency Medicine CurrentSince Jul 10, 2019 Accepting new patients
North Shore-Lij Medical PC Emergency Medicine CurrentSince Feb 21, 2019 Accepting new patients
State of New York Comptrollers Office Past Accepting new patients
University Hospital of Brooklyn Suny Downstate Health Sciences Univers Past Accepting new patients

Locations

1545 Atlantic Ave
Brooklyn, NY 11213
Phone (718) 613-4175

1176 5th Ave
New York, NY 10029
Phone (212) 241-6237

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

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

300 Community Dr
Plandome, NY 11030

Organizations & group practices 8

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 4

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": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330992000000",
    "number": "1760477418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 LENOX RD",
            "address_2": "BOX 1262",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032017",
            "telephone_number": "718-245-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 LENOX RD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032017",
            "telephone_number": "718-245-4790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERMANN",
        "first_name": "JONATHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2012-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "233336-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02602431",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.