Individual provider Active NPI

John Phair, MD

  • Vascular Surgery Physician
  • Long Island City, NY
National Provider Identifier
1033539705
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
69564 Issued in CT
Practice address
25-20 30TH Avenue
5TH Floor
Long Island City, NY 11102
Phone
(718) 808-7777
NPI assigned
Apr 22, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 298106 NY
Vascular Surgery Physician 2086S0129X 69564 CT Primary

Addresses

Primary practice location

25-20 30TH Avenue
5TH Floor
Long Island City, NY 11102

Mailing address

1212 5TH Ave Unit 2
New York, NY 10029-5210
Phone (212) 241-7120

Other identifiers 1

IdentifierTypeStateIssuer
8168138MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL NewYork

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190731002893 NY Practitioner - General SurgeryPractitioner - Vascular Surgery 2769722925 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Albert Einstein College of Medicine of Yeshiva University, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

1 Gustave L Levy PL
New York, NY 10029-6504
Phone (212) 241-6500

Hospital & facility affiliations

  • Mount Sinai Hospital Hospital, New York, NY, CCN 330024

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal16
Leg revascularization (restoring blood flow)61
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
69564CTMDVascular Surgery Physician
298106NYMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Vascular Surgery CurrentSince Aug 18, 2019 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 1, 2019 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Aug 18, 2019 Accepting new patients
Metropolitan Medical Practice Plan PC CurrentSince Oct 1, 2019 Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 1, 2019 Accepting new patients
Mount Sinai Hospital Past Accepting new patients
Mount Sinai Hospital Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

7901 Broadway
Rm A119
Elmhurst, NY 11373
Phone (718) 334-3915

13620 38th Ave
Flushing, NY 11354
Phone (718) 353-7701

2520 30th Ave
Fl 5
Long Island City, NY 11102
Phone (718) 808-7777

1901 1st Ave
New York, NY 10029
Phone (212) 230-6262

5 E 98th St
New York, NY 10029
Phone (212) 241-3986

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

10114 Liberty Ave
#13292
Ozone Park, NY 11417
Phone (718) 487-3330

9901 Queens Blvd
Rego Park, NY 11374
Phone (718) 268-4500

Networks

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

Interoperability endpoints

  • Direct secure messaging: jphair844027@nychhc.direct-ci.com

Organizations & group practices 9

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": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1033539705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 5TH AVE UNIT 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100295210",
            "telephone_number": "212-241-7120",
            "fax_number": "718-881-5074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25-20 30TH AVENUE",
            "address_2": "5TH FLOOR",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "11102",
            "telephone_number": "718-808-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAIR",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-22",
        "last_updated": "2021-10-19",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NY",
            "license": "298106",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CT",
            "license": "69564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8168138",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "NewYork",
            "affiliation": "N",
            "address_1": "1212 5th Ave",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100295210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

Verify at the official NPI Registry.