Individual provider Active NPI

Assata Thomas

  • Mental Health Counselor
  • New York, NY
National Provider Identifier
1871066712
Registry record updated Jan 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
2090 Adam Clayton Powell Jr Blvd
New York, NY 10027-4990
Phone
(347) 963-7492
NPI assigned
Jan 3, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

2090 Adam Clayton Powell Jr Blvd
New York, NY 10027-4990

Mailing address

590 Avenues of Americas
New York, NY 10011-9904

Other identifiers 1

IdentifierTypeStateIssuer
804144973MedicaidNY

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260610003291 NY Practitioner - Mental Health Counselor 5395217301 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2001 Story Ave
Apt 4O
Bronx, NY 10473-2023

535 Mack Ave
Kingsley, MI 49649-9220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shine Medical Providers PC Single Specialty Past 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": "1546473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546473600000",
    "number": "1871066712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 AVENUES OF AMERICAS",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100119904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 ADAM CLAYTON POWELL JR BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274990",
            "telephone_number": "347-963-7492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "ASSATA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-03",
        "last_updated": "2019-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804144973",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.