NPIMap

Individual provider Active NPI

Anyanate Gwendolyne Jack, M.D., MPH

  • Endocrinology, Diabetes & Metabolism Physician
  • New York, NY
National Provider Identifier
1952744104
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
2928521 Issued in NY
Practice address
211 E 80TH St FL 2
New York, NY 10075
Phone
(646) 962-8690
NPI assigned
Apr 8, 2013
Last updated
Jul 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 2928521 NY Primary

Addresses

Primary practice location

211 E 80TH St FL 2
New York, NY 10075

Mailing address

525 E 68TH St # 2026
New York, NY 10065-4870

Other practice location 1

330 Brookline Ave
Boston, MA 02215-5400
Phone (617) 667-9344

Other practice location 2

525 E 68th St # 2026
New York, NY 10065-4870
Phone (646) 962-8690

Other names 1

  • Dr. Gwendolyne Anyanate Jack Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180809005242 NY Practitioner - EndocrinologyPractitioner - Internal Medicine 3577709146 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

525 E 68TH St RM
F20 Endocrinology Group
New York, NY 10065-4870
Phone (212) 746-6290

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2928521NYMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Weill Medical College of Cornell CurrentSince Jul 1, 2018 Accepting new patients
Weill Medical College of Cornell Endocrinology, Diabetes & Metabolism CurrentSince Jul 1, 2018 Accepting new patients

Locations

211 E 80th St
Fl 2
New York, NY 10075
Phone (646) 962-6828

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

525 E 68th St
#2026
New York, NY 10065
Phone (646) 962-8690

525 E 68th St
Rm F20
New York, NY 10065
Phone (212) 746-6290

Networks

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

Interoperability endpoints

  • Direct secure messaging: gwj9003@direct.nyp.org

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
William F Ryan Community Health Center IncNew York, NY, CCN 331826 Federally qualified health center Corporate Director Jul 1, 2019
The Ryan Women & Childrens CenterNew York, NY, CCN 331013 Federally qualified health center Corporate Officer Jul 1, 2019
Ryan Health|Frederick DouglassNew York, NY, CCN 571050 Federally qualified health center Corporate Director Jul 1, 2019
Ryan Health | WadsworthNew York, NY, CCN 571814 Federally qualified health center Corporate Director Jul 1, 2019

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531785600000",
    "number": "1952744104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E 68TH ST # 2026",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 E 80TH ST FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10075",
            "telephone_number": "646-962-8690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 Brookline Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "022155400",
            "country_code": "US",
            "telephone_number": "617-667-9344",
            "fax_number": "617-667-7060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "525 E 68th St # 2026",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100654870",
            "country_code": "US",
            "telephone_number": "646-962-8690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACK",
        "first_name": "ANYANATE",
        "middle_name": "GWENDOLYNE",
        "name_prefix": "Dr.",
        "credential": "M.D., MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-08",
        "last_updated": "2018-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NY",
            "license": "2928521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GWENDOLYNE",
            "last_name": "JACK",
            "middle_name": "ANYANATE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.