Individual provider Active NPI

Jennat Z Mustafa, PA-C

  • Medical Physician Assistant
  • New York, NY
National Provider Identifier
1922475904
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
018945-1 Issued in NY
Practice address
1275 York Ave
New York, NY 10065-6007
Phone
(718) 920-4321
NPI assigned
Aug 26, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 018945-1 NY Primary

Addresses

Primary practice location

1275 York Ave
New York, NY 10065-6007

Mailing address

145 W 67TH St Apt 26a
New York, NY 10023-5937
Phone (508) 868-6649

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
I20151217000568 NY Practitioner - Physician Assistant 5597066530 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
80.33
Improvement activities
40
Cost
62.28

Merit-based Incentive Payment System (MIPS)

Final score
79.57 of 100Reported as group
Quality
70.48
Improvement activities
40
Cost
69.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018945-1NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Oct 15, 2015 Accepting new patients
Montefiore Medical Center CurrentSince Oct 15, 2015 Accepting new patients
Mskcc Clinical Practice Plan CurrentSince Jul 18, 2024 Accepting new patients
Memorial Hematology Lymphoma Group CurrentSince Jul 18, 2024 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

633 3rd Ave
Fl 4
New York, NY 10017
Phone (646) 227-3764

1275 York Ave
New York, NY 10065
Phone (212) 639-3813

Networks

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

Interoperability endpoints

  • Direct secure messaging: jmustafa29911@mskcc.direct-ci.com

Organizations & group practices 4

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": "1440547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1922475904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 W 67TH ST APT 26A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100235937",
            "telephone_number": "508-868-6649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656007",
            "telephone_number": "718-920-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSTAFA",
        "first_name": "JENNAT",
        "middle_name": "Z",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-26",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "018945-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.