Individual provider Active NPI

Timothy Michael O'Connor, C.N.S.

  • Psychiatric/Mental Health Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1770779126
Registry record updated May 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F401805-1 Issued in NY
Practice address
2928 W 36TH St
Brooklyn, NY 11224-1410
Phone
(718) 372-3300
Fax
(718) 972-1314
NPI assigned
Sep 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F401805-1 NY Primary
Registered Nurse 163W00000X 278191 MA

Addresses

Primary practice location

2928 W 36TH St
Brooklyn, NY 11224-1410

Mailing address

2928 W 36TH St
Brooklyn, NY 11224-1410
Phone (718) 372-3300

Other identifiers 1

IdentifierTypeStateIssuer
04067387MedicaidNY

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
I20150522000834 NY Practitioner - Nurse Practitioner 9335296144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

195 Montague St
Brooklyn, NY 11201-3628
Phone (718) 488-0100

Merit-based Incentive Payment System (MIPS)

Final score
87.65 of 100Reported as group
Quality
71.56
Promoting interoperability
74
Improvement activities
40
Cost
87.55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Jewish Board of Family and Children'S Services, Inc. Psychiatric/Mental Health CurrentSince May 1, 2015 Accepting new patients
Jewish Board of Family & Childrens Services Inc CurrentSince May 1, 2015 Accepting new patients
Jewish Board of Family and Children'S Services, Inc Past Accepting new patients

Locations

3600 Jerome Ave
Bronx, NY 10467
Phone (718) 366-8400

938 Kings Hwy
Brooklyn, NY 11223
Phone (718) 998-3235

1273 53rd St
Brooklyn, NY 11219
Phone (718) 435-5700

2020 Coney Island Ave
Brooklyn, NY 11223
Phone (718) 676-4210

Organizations & group practices 3

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": "1190160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462838400000",
    "number": "1770779126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2928 W 36TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112241410",
            "telephone_number": "718-372-3300",
            "fax_number": "718-972-1314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2928 W 36TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112241410",
            "telephone_number": "718-372-3300",
            "fax_number": "718-972-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "TIMOTHY",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "C.N.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-19",
        "last_updated": "2016-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F401805-1",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "278191",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04067387",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.