Individual provider Active NPI

Artem Yusupov, AUD

  • Audiologist
  • Forest Hills, NY
National Provider Identifier
1053765388
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
00255881 Issued in NY
Practice address
10825 72ND Ave
Ste 1a
Forest Hills, NY 11375-7831
Phone
(718) 480-8556
Fax
(347) 561-9513
NPI assigned
Apr 23, 2016
Last updated
Mar 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 00255881 NY Primary

Addresses

Primary practice location

10825 72ND Ave
Ste 1a
Forest Hills, NY 11375-7831

Mailing address

10825 72ND Ave
Ste 1a
Forest Hills, NY 11375-7831
Phone (347) 561-9535

Other practice location 1

9315 Jamaica Ave
Woodhaven, NY 11421-2220
Phone (718) 237-2284

Other identifiers 5

IdentifierTypeStateIssuer
1134597701OtherNYGROUP NPI
A100146813OtherNYSOLO MEDICARE PTAN
002588-1OtherNYNYS AUDIOLOGY LICENSE
A400146814OtherNYGROUP MEDICARE PTAN
04407801MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160620000065 NY Practitioner - Qualified Audiologist 3072804277 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10825 72ND Ave
Suite 1a
Forest Hills, NY 11375-7831
Phone (347) 561-9535

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00255881NYMDAudiologist

Networks

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

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742169600000",
    "number": "1053765388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10825 72ND AVE",
            "address_2": "STE 1A",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757831",
            "telephone_number": "347-561-9535",
            "fax_number": "347-561-9513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10825 72ND AVE",
            "address_2": "STE 1A",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757831",
            "telephone_number": "718-480-8556",
            "fax_number": "347-561-9513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9315 Jamaica Ave",
            "address_purpose": "LOCATION",
            "city": "Woodhaven",
            "state": "NY",
            "postal_code": "114212220",
            "country_code": "US",
            "telephone_number": "718-237-2284",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YUSUPOV",
        "first_name": "ARTEM",
        "credential": "AUD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-23",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NY",
            "license": "00255881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1134597701",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOLO MEDICARE PTAN",
            "identifier": "A100146813",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS AUDIOLOGY LICENSE",
            "identifier": "002588-1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE PTAN",
            "identifier": "A400146814",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04407801",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.