Individual provider Active NPI

Rafael Bacani Roque, NP

  • Family Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1952054090
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F346423 Issued in NY
Practice address
150 55TH St
Brooklyn, NY 11220-2508
Phone
(917) 679-8317
NPI assigned
Jan 29, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F346423 NY Primary

Addresses

Primary practice location

150 55TH St
Brooklyn, NY 11220-2508

Mailing address

9255 Shore Rd Apt 2C
Brooklyn, NY 11209-6538

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
I20231128001331 NY Practitioner - Nurse Practitioner 0143678474 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

150 55TH St
Brooklyn, NY 11220-2508
Phone (718) 630-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F346423NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Oct 16, 2023 Accepting new patients
New York University CurrentSince Oct 16, 2023 Accepting new patients

Locations

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Interoperability endpoints

  • Direct secure messaging: rroque128064@nyumc.direct-ci.com

Organizations & group practices 2

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1643414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1952054090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9255 SHORE RD APT 2C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112096538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 55TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112202508",
            "telephone_number": "917-679-8317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROQUE",
        "first_name": "RAFAEL",
        "middle_name": "BACANI",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-29",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F346423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.