Individual provider Active NPI

Nikita Mishra

  • Physician Assistant
  • Glendale, AZ
National Provider Identifier
1902623671
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
19555 N 59TH Ave
Glendale, AZ 85308-6813
Phone
(623) 572-3200
NPI assigned
Sep 24, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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 Primary

Addresses

Primary practice location

19555 N 59TH Ave
Glendale, AZ 85308-6813

Mailing address

19555 N 59TH Ave
Glendale, AZ 85308-6813

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
I20260223003149 NY Practitioner - Physician Assistant 2163903659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1027 46TH Ave
Long Island City, NY 11101-5202

1027 46TH Ave
Long Island City, NY 11101-5245

220 Front St
New York, NY 10038-2031

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Derm Specs of PA PLLC CurrentSince Jan 14, 2026 Accepting new patients
Bobby Buka, M.D., P.C. CurrentSince Jan 14, 2026 Accepting new patients
Atlas Infectious Disease Practice PLLC Past Accepting new patients
Mount Sinai Hospital Past Accepting new patients
Out East Medical PastSince Jun 15, 2021 Accepting new patients

Locations

3179 Steinway St
Astoria, NY 11103

1163 Myrtle Ave
Brooklyn, NY 11206

1027 46th Ave
Fl 1
Long Island City, NY 11101

625 10th Ave
New York, NY 10036

1425 2nd Ave
New York, NY 10021

214 Sullivan St
New York, NY 10012

2121 Adam Clayton Powell Jr Blvd
New York, NY 10027
Phone (718) 534-8190

3531 Long Beach Rd
Oceanside, NY 11572

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22363/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/BFCDAA

Organizations & group practices 5

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": "1727136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1902623671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19555 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19555 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086813",
            "telephone_number": "623-572-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISHRA",
        "first_name": "NIKITA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-24",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.