NPIMap

Individual provider Active NPI

Meyer David Gershbaum, MD

  • Specialist
  • Flushing, NY
National Provider Identifier
1033108220
Registry record updated May 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
208375 Issued in NY
Practice address
5842 Main St
Flushing, NY 11355-5336
Phone
(718) 353-3710
Fax
(718) 463-0400
NPI assigned
Oct 19, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 208375 NY Primary

Addresses

Primary practice location

5842 Main St
Flushing, NY 11355-5336

Mailing address

365 Woodmere Blvd
Woodmere, NY 11598-2047
Phone (516) 812-8662

Other identifiers 1

IdentifierTypeStateIssuer
02520730MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051229000465 NY Practitioner - Urology 4789606013 Reassigns benefits to 1 organization
I20221114001498 IL Practitioner - Urology 4789606013 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Albert Einstein College of Medicine of Yeshiva University, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

221 NE Glen Oak Ave
Peoria, IL 61636-0001

5401 N Knoxville Ave
Peoria, IL 61614-5021

5409 N Knoxville Ave
Peoria, IL 61614-5069
Phone (309) 691-1000

600 S 13TH St
Pekin, IL 61554-4936

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Carle Health Care Incorporated CurrentSince Jan 3, 2026 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Nov 17, 2022 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Nov 17, 2022 Accepting new patients
Tarasuk & Farrell Urologiocal Associated Past Accepting new patients
Integrated Medical Professionals PLLC Past Accepting new patients

Locations

1776 Westlakes Pkwy
Ste 400
West Des Moines, IA 50266
Phone (515) 241-6161

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

5409 N Knoxville Ave
Ste 102
Peoria, IL 61614
Phone (309) 682-9898

5401 N Knoxville Ave
Ste 102
Peoria, IL 61614
Phone (309) 643-6131

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

815 Main St
Ste A1
Peoria, IL 61602

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

Philadelphia, PA 19195

Organizations & group practices 8

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.

Hospital & facility affiliations 6

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": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336089600000",
    "number": "1033108220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 WOODMERE BLVD",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115982047",
            "telephone_number": "516-812-8662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5842 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555336",
            "telephone_number": "718-353-3710",
            "fax_number": "718-463-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERSHBAUM",
        "first_name": "MEYER",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2012-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "208375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02520730",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.