Active NPI
Nicole Agatha Camacho, NP
- Family Nurse Practitioner
- Bronx, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 354274
- Practice address
- 3400 Bainbridge Ave FL 4
Bronx, NY 10467-2404 - Phone
- (718) 920-4800
- NPI assigned
- Mar 14, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 637965 | NY | |
| Family Nurse Practitioner | 363LF0000X | 354274 | NY | Primary |
Addresses
Primary practice location
3400 Bainbridge Ave FL 4
Bronx, NY 10467-2404
Mailing address
670 Midwood Rd
Ridgewood, NJ 07450-5518
Phone (347) 415-3178
Other practice location 1
3073 Buhre Ave Apt 5H
Bronx, NY 10461-4737
Phone (347) 415-3178
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255
3400 Bainbridge Ave
Bronx, NY 10467-2404
Phone (914) 378-6148
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 637965 | NY | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montefiore Medical Center | Current | Accepting new patients | |
| Liliana Lopez NP in Family Health PC | Family | Current | Accepting new patients |
| Montefiore Medical Center | Current | Accepting new patients | |
| Montefiore Mount Vernon Hospital | Past | Accepting new patients |
Locations
111 E 210th St
Bronx, NY 10467
12 Broadway
Haverstraw, NY 10927
Phone (845) 499-5696
25 S Main St
Ste E
Spring Valley, NY 10977
Phone (845) 499-5496
100 Corporate Dr
Ste 100
Yonkers, NY 10701
Phone (914) 378-6148
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Interoperability endpoints
- ncamacho@montefioredirect.com
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.
-
- Anesthesiology Physician
- Bronx, NY
- NPI 1063525152
-
- Family Nurse Practitioner
- Spring Valley, NY
- NPI 1356885180
-
- Community/Retail Pharmacy
- Bronx, NY
- NPI 1194183715
-
- General Acute Care Hospital
- Mount Vernon, NY
- NPI 1013345065
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Bronx, NY
- NPI 1952476988
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734393600000",
"number": "1790544526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 MIDWOOD RD",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "074505518",
"telephone_number": "347-415-3178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 BAINBRIDGE AVE FL 4",
"city": "BRONX",
"state": "NY",
"postal_code": "104672404",
"telephone_number": "718-920-4800"
}
],
"practiceLocations": [
{
"address_1": "3073 Buhre Ave Apt 5H",
"address_purpose": "LOCATION",
"city": "Bronx",
"state": "NY",
"postal_code": "104614737",
"country_code": "US",
"telephone_number": "347-415-3178",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CAMACHO",
"first_name": "NICOLE",
"middle_name": "AGATHA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-14",
"last_updated": "2024-12-17",
"certification_date": "2024-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "637965",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "354274",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.