Individual provider Active NPI

Nicketta McPherson, RPA-C

  • Physician Assistant
  • Bronx, NY
National Provider Identifier
1891039756
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
015757-1 Issued in NY
Practice address
2015 Grand Concourse
Bronx, NY 10453
Phone
(718) 229-7295
NPI assigned
Nov 15, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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 015757-1 NY Primary

Addresses

Primary practice location

2015 Grand Concourse
Bronx, NY 10453

Mailing address

2015 Grand Concourse
Bronx, NY 10453-4303
Phone (718) 229-7295

Other practice location 1

25 East 183rd Street
Morris Heights Health Center
Bronx, NY 10453
Phone (718) 716-4400

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151123000468 NY Practitioner - Physician Assistant 7416257555 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
015757-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Essen Medical Associates,PC CurrentSince Jun 1, 2018 Accepting new patients
Morris Heights Health Center, Inc. CurrentSince Sep 23, 2015 Accepting new patients
Sun River Health Inc. CurrentSince Aug 21, 2019 Accepting new patients
Sun River Health Inc CurrentSince Aug 21, 2019 Accepting new patients

Locations

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

25 E 183rd St
Bronx, NY 10453
Phone (718) 483-1270

2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200

85 W Burnside Ave
Bronx, NY 10453
Phone (718) 483-1270

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

Networks

  • 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": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1891039756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104534303",
            "telephone_number": "718-229-7295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10453",
            "telephone_number": "718-229-7295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 East 183rd Street",
            "address_2": "Morris Heights Health Center",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "10453",
            "country_code": "US",
            "telephone_number": "718-716-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCPHERSON",
        "first_name": "NICKETTA",
        "name_prefix": "Miss",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015757-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.