THEODOR BROCKWAY
NPI 1902390693
Nurse Anesthetist, Certified Registered in New York, NY
About Theodor Brockway NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
THEODOR BROCKWAY (NPI 1902390693) is an individual nurse anesthetist, certified registered in New York, New York, licensed in New York (702059) and active in the NPI registry since June 2018. He is a graduate of Other (2018).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Theodor Brockway is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
5Medicare enrollment records show Theodor Brockway reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
New York, NY 10016
- Reassigned Medicare billing, New York enrollment
- 1,074 clinicians in this Medicare group
New York, NY 10029
- Reassigned Medicare billing, New York enrollment
- 245 clinicians in this Medicare group
Lubbock, TX 79430
- Reassigned Medicare billing, Texas enrollment
- 685 clinicians in this Medicare group
Las Vegas, NM 87701
- Reassigned Medicare billing, New Mexico enrollment
- 70 clinicians in this Medicare group
Kykotsmovi, AZ 86039
- Reassigned Medicare billing, Texas enrollment
- 540 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 10016 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
NEW YORK, NY 10016
NEW YORK, NY 10016
NEW YORK, NY 10016
NEW YORK, NY 10016
NEW YORK, NY 10016
NEW YORK, NY 10016
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 Theodor Brockway's NPI number?
The NPI number for Theodor Brockway is 1902390693. It was assigned to this individual provider in the NPPES registry on June 18, 2018.
Where is Theodor Brockway located?
Theodor Brockway practices at 550 1st Ave, New York, NY 10016. The listed phone number is (212) 263-7300.
What is Theodor Brockway's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Theodor Brockway enrolled in Medicare?
Yes. Theodor Brockway is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Theodor Brockway's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Theodor Brockway reassigns Medicare benefits to 5 organizations: New York University (New York, NY), Icahn School Of Medicine At Mount Sinai (New York, NY), Texas Tech University Health Sciences Center Lubbock (Lubbock, TX), Netherlands Anesthesia, LLC (Las Vegas, NM) and Tuba City Regional Health Care Corporation (Kykotsmovi, AZ). 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 Theodor Brockway's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Theodor Brockway accept?
Health plans from Blue Cross and Blue Shield of Texas, CareSource and Cigna Healthcare list Theodor Brockway as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Theodor Brockway was last updated on August 9, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Theodor Brockway · NPI 1902390693
Nurse Anesthetist, Certified Registered physician in New York, New York. Individual provider, active in the CMS NPPES registry since June 18, 2018.
## Identity
- **NPI:** 1902390693 (Entity type: Individual)
- **Enumerated:** June 18, 2018
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 702059 (New York)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 550 1ST AVE, New York, NY 10016
- **Phone:** (212) 263-7300
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** 5 organizations under Medicare reassignment (form CMS-855R): New York University (NPI 1114121928, New York, NY); Icahn School Of Medicine At Mount Sinai (NPI 1447008446, New York, NY); Texas Tech University Health Sciences Center Lubbock (NPI 1063461358, Lubbock, TX); Netherlands Anesthesia, LLC (NPI 1922603562, Las Vegas, NM); Tuba City Regional Health Care Corporation (NPI 1396921870, Kykotsmovi, AZ) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2018
## Record status
- **NPPES last updated:** August 9, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1902390693) · Data from the CMS NPPES public registry.