Individual provider Active NPI

Tomas Havranek, MD

  • Neonatal-Perinatal Medicine Physician
  • Bronx, NY
National Provider Identifier
1881604601
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
216275 Issued in NY
Practice address
1601 Tenbroeck Ave
Bronx, NY 10461-2007
Phone
(314) 440-9242
NPI assigned
Aug 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2006034636 MO
Neonatal-Perinatal Medicine Physician 2080N0001X 2006034636 MO
Neonatal-Perinatal Medicine Physician 2080N0001X 216275 NY Primary

Addresses

Primary practice location

1601 Tenbroeck Ave
Bronx, NY 10461-2007

Mailing address

1601 Tenbroeck Ave
Bronx, NY 10461-2007
Phone (314) 440-9242

Other practice location 1

1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone (314) 577-5642

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140307000433 NY Practitioner - Pediatric Medicine 6002916970 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2006034636MOMDNeonatal-Perinatal Medicine Physician
216275NYMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Nov 20, 2013 Accepting new patients
Montefiore Medical Center Pediatrics CurrentSince Nov 20, 2013 Accepting new patients
Stony Brook Children'S Service, University Faculty Practice Corporatio Pediatrics CurrentSince Oct 25, 2023 Accepting new patients
SSM Health Care St. Louis Pediatrics Past Accepting new patients
University Medical Service Association Inc Past Accepting new patients
SSM Health Care St. Louis Pediatrics Past Accepting new patients
Long Island College Hospital Pediatrics Past Accepting new patients
University Hospital at Stony Brook Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

2701 Sunrise Hwy
Islip Terrace, NY 11752
Phone (631) 444-6300

Networks

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

Organizations & group practices 8

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": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1881604601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 TENBROECK AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612007",
            "telephone_number": "314-440-9242",
            "fax_number": "317-977-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 TENBROECK AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612007",
            "telephone_number": "314-440-9242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1465 S Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631041003",
            "country_code": "US",
            "telephone_number": "314-577-5642",
            "fax_number": "314-268-6410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAVRANEK",
        "first_name": "TOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2006034636",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MO",
            "license": "2006034636",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NY",
            "license": "216275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.