Individual provider Active NPI

Mitchell C Li, NP

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1992326771
Registry record updated May 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
309034 Issued in NY
Practice address
177 Fort Washington Ave
New York, NY 10032-3733
Phone
(212) 305-6469
NPI assigned
May 2, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 309034 NY Primary

Addresses

Primary practice location

177 Fort Washington Ave
New York, NY 10032-3733

Mailing address

177 Fort Washington Ave
New York, NY 10032-3733
Phone (212) 305-6469

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
I20200910000949 NY Practitioner - Nurse Practitioner 0547688319 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
309034NYMDPlastic Surgery within the Head & Neck (Otolaryngology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Nov 10, 2024 Accepting new patients
North Shore - Lij Medical PC CurrentSince Nov 10, 2024 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jun 6, 2020 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jun 6, 2020 Accepting new patients
Trustees of Columbia University in the City of New York Past Accepting new patients

Locations

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

177 Fort Washington Ave
New York, NY 10032
Phone (212) 305-3090

410 Lakeville Rd
North New Hyde Park, NY 11042
Phone (516) 465-3270

300 Community Dr
Plandome, NY 11030

Networks

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

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: mcl9006@direct.nyp.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1588377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588377600000",
    "number": "1992326771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 FORT WASHINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323733",
            "telephone_number": "212-305-6469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 FORT WASHINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323733",
            "telephone_number": "212-305-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LI",
        "first_name": "MITCHELL",
        "middle_name": "C",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-02",
        "last_updated": "2020-05-02",
        "certification_date": "2020-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "309034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.