Individual provider Active NPI

Humberto Gerardo Mendoza, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Bridgeport, CT
National Provider Identifier
1902284110
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
267 Grant Street
Med Ed Podium 4
Bridgeport, CT 06610-0120
Phone
(203) 384-4442
NPI assigned
May 8, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

267 Grant Street
Med Ed Podium 4
Bridgeport, CT 06610-0120

Mailing address

267 Grant Street
Med Ed Podium 4
Bridgeport, CT 06610-0120

Other practice location 1

1400 Pelham Pkwy S
Bronx, NY 10461-1138
Phone (718) 918-3045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, CT2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160615001104 OH Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 9032400452
I20240712003641 CT Order and Referring Only - Diagnostic RadiologyPractitioner - Diagnostic Radiology 9032400452

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: hmendoza845105@nychhc.direct-ci.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1902284110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 GRANT STREET",
            "address_2": "MED ED PODIUM 4",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066100120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 GRANT STREET",
            "address_2": "MED ED PODIUM 4",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066100120",
            "telephone_number": "203-384-4442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Pelham Pkwy S",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104611138",
            "country_code": "US",
            "telephone_number": "718-918-3045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "HUMBERTO",
        "middle_name": "GERARDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-08",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.