Individual provider Active NPI

Juana Evangelista Hernandez, MD

  • Family Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1851392856
Registry record updated May 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
237919-1 Issued in NY
Practice address
5616 6TH Ave
Brooklyn, NY 11220
Phone
(718) 439-5440
Fax
(718) 567-9772
NPI assigned
Aug 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 237919-1 NY Primary

Addresses

Primary practice location

5616 6TH Ave
Brooklyn, NY 11220

Mailing address

5616 6TH Ave
Brooklyn, NY 11220-3419
Phone (718) 439-5440

Other identifiers 1

IdentifierTypeStateIssuer
02792996MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20170926000578 NC Order and Referring Only - Family PracticePractitioner - Family Practice 4082683834

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
237919-1NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Camellia Foundation Family Medicine PastSince Sep 7, 2011 Accepting new patients
Medicos General PLLC Family Medicine PastSince Aug 4, 2010 Accepting new patients

Organizations & group practices 2

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": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305763200000",
    "number": "1851392856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5616 6TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203419",
            "telephone_number": "718-439-5440",
            "fax_number": "718-492-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5616 6TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11220",
            "telephone_number": "718-439-5440",
            "fax_number": "718-567-9772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "JUANA",
        "middle_name": "EVANGELISTA",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-02",
        "last_updated": "2011-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "237919-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02792996",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.