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KATIE RAE FORMAN D.O.
NPI 1265664692
Pediatrics - Neonatal-Perinatal Medicine in Bronx, NY

Active since August 18, 2009PECOS Enrolled
1601 TENBROECK AVE, 2ND FLOOR, BRONX, NY 10461(718) 904-4105 Get Directions Write a Review

NPPES record last updated: July 25, 2013. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Katie Rae Forman D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATIE RAE FORMAN D.O. (NPI 1265664692) is an individual neonatal-perinatal medicine provider in Bronx, New York, licensed in District Of Columbia (DO034307) and active in the NPI registry since August 2009. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1265664692
Entity TypeIndividualFemale
Primary Taxonomy2080N0001X
Provider Legal NameKATIE RAE FORMANCredential: D.O.
Location Address1601 TENBROECK AVE, 2ND FLOORBronx, NY 10461-2007
Mailing Address1601 Tenbroeck Ave, 2nd FloorBronx, NY 10461-2007 · (718) 904-4105
Phone(718) 904-4105
Sole ProprietorNo
Enumeration DateAugust 18, 2009
Last NPPES UpdateJuly 25, 2013
✔ NPI 1265664692 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Neonatal-Perinatal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080N0001X
License✔ Licensed in DC · DO034307
Definition
A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
Also ListedPediatricsTaxonomy 208000000X · License 251142 (NY)
1601 TENBROECK AVE, Bronx, NY 10461
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Katie Rae Forman D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Katie Forman reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Montefiore Medical Center
2.8 mi
Anesthesiology
111 E 210TH ST
Bronx, NY 10467
  • Reassigned Medicare billing, New York enrollment
  • 5,251 clinicians in this Medicare group
NPI 1063525152 (914) 378-6021
North Shore-Lij Medical PC
8.5 mi
Urology
1010 NORTHERN BLVD STE 110
Great Neck, NY 11021
  • Reassigned Medicare billing, New York enrollment
  • 9,353 clinicians in this Medicare group
NPI 1053688572 (516) 321-7400
Mount Sinai School Of Medicine
15 mi
Cardiovascular Disease
10 E MERRICK RD STE 207
Valley Stream, NY 11580
  • Reassigned Medicare billing, New York enrollment
  • 302 clinicians in this Medicare group
NPI 1942777347 (516) 256-2017

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. LANCE RICHARD BRUCK
Obstetrics & Gynecology
1601 TENBROECK AVE
BRONX, NY 10461
Bronx County (718) 430-8701
TOMAS HAVRANEK MD
Pediatrics (Neonatal-Perinatal Medicine)
1601 TENBROECK AVE
BRONX, NY 10461
Bronx County (314) 440-9242

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Katie Forman's NPI number?

The NPI number for Katie Forman is 1265664692. It was assigned to this individual provider in the NPPES registry on August 18, 2009.

Where is Katie Forman located?

Katie Forman practices at 1601 Tenbroeck Ave 2nd Floor, Bronx, NY 10461. The listed phone number is (718) 904-4105.

What is Katie Forman's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Neonatal-Perinatal Medicine, with taxonomy code 2080N0001X.

Is Katie Forman enrolled in Medicare?

Yes. Katie Forman is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Katie Forman's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Katie Forman reassigns Medicare benefits to 3 organizations: Montefiore Medical Center (Bronx, NY), North Shore-Lij Medical PC (Great Neck, NY) and Mount Sinai School Of Medicine (Valley Stream, NY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Katie Forman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Katie Forman was last updated on July 25, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.