Individual provider Active NPI

Antonia Rogado Sepulveda, M.D.

  • Anatomic Pathology Physician
  • Ny, NY
National Provider Identifier
1831164110
Registry record updated Aug 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
License
268045 Issued in NY
Practice address
630 West 168TH VC14-212
Ny, NY 10032
Phone
(412) 647-6125
NPI assigned
Feb 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD071773L PA
Anatomic Pathology Physician 207ZP0101X 268045 NY Primary

Addresses

Primary practice location

630 West 168TH VC14-212
Ny, NY 10032

Mailing address

630 West 168TH VC14-212
Ny, NY 10032
Phone (412) 647-6125

Other identifiers 1

IdentifierTypeStateIssuer
001829553MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20130716000410 NY Practitioner - Pathology 7113926759 Reassigns benefits to 1 organization
I20191210001587 DC Practitioner - Pathology 7113926759 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Faculty Associates, IncGroup PAC ID 4082528898, 676 clinicians

Practice addresses (Care Compare)

1200 Pecan St SE
Washington, DC 20032-2652
Phone (771) 444-6200

900 23Rd St NW
Washington, DC 20037-2342
Phone (202) 715-4000

Hospital & facility affiliations

  • George Washington Univ Hospital Hospital, Washington, DC, CCN 090001
  • Cedar Hill Regional Medical Center Hospital, Washington, DC, CCN 090012

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York CurrentSince Aug 1, 2018 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Aug 1, 2018 Accepting new patients
Trustees of Columbia University in the City of New York Current Accepting new patients
Medical Faculty Associates, Inc CurrentSince Oct 30, 2019 Accepting new patients
Trustees of Columbia University at Palisades Medical Center Anatomic Pathology Past Accepting new patients

Locations

900 23rd St NW
Washington, DC 20037
Phone (202) 715-4750

2021 K St NW
Ste 408
Washington, DC 20006
Phone (202) 223-1024

622 W 168th St
Ph 1564
New York, NY 10032
Phone (212) 305-7399

630 W 168th St
#14212
New York, NY 10032
Phone (412) 647-6125

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

630 W 168th St
#23
New York, NY 10032

630 W 168th St
New York, NY 10032
Phone (212) 305-1948

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

Hospital & facility affiliations 2

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409097600000",
    "number": "1831164110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 WEST 168TH VC14-212",
            "city": "NY",
            "state": "NY",
            "postal_code": "10032",
            "telephone_number": "412-647-6125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 WEST 168TH VC14-212",
            "city": "NY",
            "state": "NY",
            "postal_code": "10032",
            "telephone_number": "412-647-6125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEPULVEDA",
        "first_name": "ANTONIA",
        "middle_name": "ROGADO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2014-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD071773L",
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "NY",
            "license": "268045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001829553",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ny, NY

Sources for this page

Verify at the official NPI Registry.