Individual provider Active NPI

Jack Moses Mensah

  • Physician Assistant
  • Bronx, NY
National Provider Identifier
1871994277
Registry record updated Sep 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3424 Kossuth Ave
2C
Bronx, NY 10467-2410
Phone
(718) 519-5000
NPI assigned
Sep 4, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NY Primary

Addresses

Primary practice location

3424 Kossuth Ave
2C
Bronx, NY 10467-2410

Mailing address

3424 Kossuth Ave
2C
Bronx, NY 10467-2410
Phone (914) 826-0397

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170117000332 NY Practitioner - Physician Assistant 3870807456 Reassigns benefits to 6 organizations
I20250730004823 TX Practitioner - Physician Assistant 3870807456 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hunt Regional Urgent CareGroup PAC ID 1850729682, 31 clinicians

Practice addresses (Care Compare)

3206 Interstate 30
Suite B
Greenville, TX 75402-7002
Phone (903) 408-7979

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3319CTMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Clinic 21 of Connecticut LLC Past Accepting new patients

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: jmensah342059@nyumc.direct-ci.com
  • Direct secure messaging: jack.mensah@ghuc.eclinicaldirectplus.com

Organizations & group practices 9

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": "1409788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409875200000",
    "number": "1871994277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3424 KOSSUTH AVE",
            "address_2": "2C",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672410",
            "telephone_number": "914-826-0397",
            "fax_number": "347-449-5668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3424 KOSSUTH AVE",
            "address_2": "2C",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672410",
            "telephone_number": "718-519-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENSAH",
        "first_name": "JACK",
        "middle_name": "MOSES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-04",
        "last_updated": "2014-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.