NPIMap

Individual provider Active NPI

Rafael Yakutilov, M.D.

  • Neurology Physician
  • Rockaway Park, NY
National Provider Identifier
1003811720
Registry record updated Jan 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
229375 Issued in NY
Practice address
15 Beach 105TH St
Rockaway Park, NY 11694-2640
Phone
(718) 474-0023
Fax
(718) 474-2033
NPI assigned
Jun 17, 2005
Last updated
Jan 30, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2009

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 229375 NY Primary

Addresses

Primary practice location

15 Beach 105TH St
Rockaway Park, NY 11694-2640

Mailing address

15 Beach 105TH St
Rockaway Park, NY 11694-2640
Phone (718) 474-0023

Other identifiers 1

IdentifierTypeStateIssuer
02574349MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040602001429 NY Practitioner - Neurology 2163404245 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

15 Beach 105TH St
Rockaway Park, NY 11694-2640
Phone (718) 474-0023

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
21.4 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
71.34

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New York Queens Medicine and Surgery, P.C. CurrentSince Sep 3, 2018 Accepting new patients
Rafael Yakutilov Neurology, PC Neurology CurrentSince Jul 28, 2007 Accepting new patients
New York Queens Medicine and Surgery, P.C. CurrentSince Sep 3, 2018 Accepting new patients
Five Towns Neurology, PC Neurology Past Accepting new patients
Modern Medical PLLC Neurology PastSince Dec 1, 2005 Accepting new patients
Sheldon W. Miller DPM PC Past Accepting new patients

Locations

2064 Cropsey Ave
Ste 1G
Brooklyn, NY 11214
Phone (718) 975-8763

5645 Main St
Flushing, NY 11355
Phone (718) 670-1435

16303 Horace Harding Expy
Fl 2
Fresh Meadows, NY 11365
Phone (718) 888-9121

259 1st St
Mineola, NY 11501
Phone (516) 576-1820

1981 Marcus Ave
Ste 208
North New Hyde Park, NY 11042
Phone (718) 670-1415

15 Beach 105th St
Rockaway Park, NY 11694
Phone (718) 474-0023

Networks

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GDEBBA

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233273600000",
    "number": "1003811720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 BEACH 105TH ST",
            "city": "ROCKAWAY PARK",
            "state": "NY",
            "postal_code": "116942640",
            "telephone_number": "718-474-0023",
            "fax_number": "718-474-2033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 BEACH 105TH ST",
            "city": "ROCKAWAY PARK",
            "state": "NY",
            "postal_code": "116942640",
            "telephone_number": "718-474-0023",
            "fax_number": "718-474-2033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAKUTILOV",
        "first_name": "RAFAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2009-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "229375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02574349",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockaway Park, NY

Sources for this page

Verify at the official NPI Registry.