Edin Memisevich, NP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

6411 Issued in CT

Practice address

1 Long Wharf Dr
New Haven, CT 06511-5946

Phone

(203) 781-4600

Fax

(203) 781-4624

NPI assigned

Dec 15, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CT, NY, VT, ME, NJ5 enrollments

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 5

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

First Choice Health Centers IncGroup PAC ID 2769417609, 39 clinicians

Ophelia Medical Group FL PAGroup PAC ID 7810398534, 103 clinicians

Ophelia Medical Group NJ PCGroup PAC ID 0547657397, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• First Choice Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Hartford, CT
  • NPI 1215923131
  Medicare reassignment Care Compare group NPD
• Ophelia Medical Group NJ PC

  • Psychiatry Physician
  • Flanders, NJ
  • NPI 1346906179
  Medicare reassignment Care Compare group NPD
• Ophelia Medical Group FL, P.a.

  • Addiction Medicine (Family Medicine) Physician
  • Philadelphia, PA
  • NPI 1588244750

  CT, ME, NY, VT

  Medicare reassignment Care Compare group
• First Choice Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Hartford, CT
  • NPI 1215518733
  NPD
• Apt Foundation Inc

  • Methadone Clinic
  • New Haven, CT
  • NPI 1487889655
  NPD (past)
• Apt Foundation, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • New Haven, CT
  • NPI 1861558165
  NPD (past)

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

{
    "created_epoch": "1450137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483920000000",
    "number": "1992160105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LONG WHARF DR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115946",
            "telephone_number": "203-781-4600",
            "fax_number": "203-781-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LONG WHARF DR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115946",
            "telephone_number": "203-781-4600",
            "fax_number": "203-781-4624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMISEVICH",
        "first_name": "EDIN",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-15",
        "last_updated": "2017-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "6411",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CT",
            "license": "6411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008056168",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEMISEVICH MEDICAID",
            "identifier": "008063396",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004217099",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008056033",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melina Infantino Psychotherapy, LLC
• Isabella Mella Bonilla
• Elizabeth Meller, MD
• Shannon Mellon, DPT
• Edward Robert Melnick, M.D.
• Areeka Memon, DO
• Fatima Memon, M.D.
• Carlos I Mena-Hurtado, MD
• Ehud Mendel, M.D.
• Sierra Rachel Mendelsohn, MB, BCH, BAO

• Primary Care Nurse Practitioner in New Haven, CT
• Providers in New Haven, CT by specialty
• Primary Care Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.