Individual provider Active NPI

Nisali Gunawardane, M.D.

  • Neurology Physician
  • Sleepy Hollow, NY
National Provider Identifier
1992106686
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
293044-1 Issued in NY
Practice address
755 N Broadway Ste 430
Sleepy Hollow, NY 10591-1077
Phone
(914) 366-5300
Fax
(914) 366-5301
NPI assigned
Sep 12, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 293044-1 NY Primary

Addresses

Primary practice location

755 N Broadway Ste 430
Sleepy Hollow, NY 10591-1077

Mailing address

755 N Broadway Ste 430
Sleepy Hollow, NY 10591-1077
Phone (914) 366-5300

Other practice location 1

1400 Pelham Parkway South - Jacobi Medical Center
Department of Medicine, Building 1 3N - 21C
Bronx, NY 10461
Phone (917) 205-1455

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200921002481 NY Practitioner - Neurology 5991044406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

755 N Broadway
Suite 430
Sleepy Hollow, NY 10591-1077
Phone (914) 366-5300

Hospital & facility affiliations

  • Phelps Hospital Hospital, Sleepy Hollow, NY, CCN 330261
  • Northern Westchester Hospital Hospital, Mount Kisco, NY, CCN 330162

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
293044NYMDLicensed Practical Nurse
293044-1NYMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Aug 31, 2020 Accepting new patients
North Shore - Lij Medical PC CurrentSince Aug 31, 2020 Accepting new patients

Locations

20 York St
North Haven, CT 06510
Phone (203) 688-2433

300 Community Dr
Plandome, NY 11030

755 N Broadway
Ste 430
Sleepy Hollow, NY 10591
Phone (914) 366-5300

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

Interoperability endpoints

  • Direct secure messaging: ngunawardane67001@northwell.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 3

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": "1410480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1992106686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 N BROADWAY STE 430",
            "city": "SLEEPY HOLLOW",
            "state": "NY",
            "postal_code": "105911077",
            "telephone_number": "914-366-5300",
            "fax_number": "914-366-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 N BROADWAY STE 430",
            "city": "SLEEPY HOLLOW",
            "state": "NY",
            "postal_code": "105911077",
            "telephone_number": "914-366-5300",
            "fax_number": "914-366-5301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Pelham Parkway South - Jacobi Medical Center",
            "address_2": "Department of Medicine, Building 1 3N - 21C",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "10461",
            "country_code": "US",
            "telephone_number": "917-205-1455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUNAWARDANE",
        "first_name": "NISALI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-12",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "293044-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sleepy Hollow, NY

Sources for this page

Verify at the official NPI Registry.