NPIMap

Organization Active NPI

Fpa Hospital Based

  • Anatomic Pathology & Clinical Pathology Physician
  • New York, NY
National Provider Identifier
1962743575
Registry record updated Feb 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
CLIA 33D1051889 Issued in NY
Legal business name
FPA HOSPITAL BASED
Practice address
1468 Madison Ave
Annenberg 15-60
New York, NY 10029-6508
Phone
(212) 731-7772
Fax
(212) 534-7491
NPI assigned
Mar 6, 2013
Organization subpart
Yes
Parent organization
FPA HOSPITAL BASEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2015

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

Authorized official

Name
Ms. Crystal Macneill, MBA
Title
VP, Cbo Director
Phone
(212) 241-6228

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Blood Banking & Transfusion Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZB0001X CLIA 33D1051889 NY
Cytopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZC0500X CLIA 33D1051889 NY
Forensic Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZF0201X CLIA 33D1051889 NY
Immunopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZI0100X CLIA 33D1051889 NY
Neuropathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZN0500X CLIA 33D1051889 NY
Molecular Genetic Pathology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0007X CLIA 33D1051889 NY
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0102X CLIA 33D1051889 NY Primary
Pediatric Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0213X CLIA 33D1051889 NY

Addresses

Primary practice location

1468 Madison Ave
Annenberg 15-60
New York, NY 10029-6508

Mailing address

1468 Madison Ave
Annenberg 15-60
New York, NY 10029-6508
Phone (212) 731-7772

Other names 1

  • MOUNT SINAI PATHOLOGY OUTREACH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130806000185 NY Part B Supplier - Clinic/Group Practice 4789826694 Receives reassigned benefits from 1,308 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New York, NY; Staten Island, NY; Brooklyn, NY; Greenlawn, NY; Jackson Heights, NY; Long Island City, NY; Manhasset, NY

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Fpa Hospital Based4 organizations share this tax ID, including this one
Part of
Fpa Hospital Based

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1468 Madison Ave
#1560
New York, NY 10029

Practitioners & affiliated clinicians

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424995200000",
    "number": "1962743575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1468 MADISON AVE",
            "address_2": "ANNENBERG 15-60",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296508",
            "telephone_number": "212-731-7772",
            "fax_number": "212-534-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 MADISON AVE",
            "address_2": "ANNENBERG 15-60",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296508",
            "telephone_number": "212-731-7772",
            "fax_number": "212-534-7491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FPA HOSPITAL BASED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FPA HOSPITAL BASED",
        "enumeration_date": "2013-03-06",
        "last_updated": "2015-02-27",
        "status": "A",
        "authorized_official_last_name": "MACNEILL",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "VP, CBO DIRECTOR",
        "authorized_official_telephone_number": "212-241-6228",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207ZB0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": "NY",
            "license": "CLIA 33D1051889",
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": "NY",
            "license": "CLIA 33D1051889",
            "primary": false
        },
        {
            "code": "207ZF0201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Forensic Pathology",
            "state": "NY",
            "license": "CLIA 33D1051889",
            "primary": false
        },
        {
            "code": "207ZI0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Immunopathology",
            "state": "NY",
            "license": "CLIA 33D1051889",
            "primary": false
        },
        {
            "code": "207ZN0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Neuropathology",
            "state": "NY",
            "license": "CLIA 33D1051889",
            "primary": false
        },
        {
            "code": "207ZP0007X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "NY",
            "license": "CLIA 33D1051889",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NY",
            "license": "CLIA 33D1051889",
            "primary": true
        },
        {
            "code": "207ZP0213X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Pediatric Pathology",
            "state": "NY",
            "license": "CLIA 33D1051889",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNT SINAI PATHOLOGY OUTREACH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.