Individual provider Active NPI

Kevin T Llewellyn, M.D.

  • Diagnostic Radiology Physician
  • Elmhurst, NY
National Provider Identifier
1063621332
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
R-7637 Issued in IA
Practice address
Mount Sinai Elmhurst Hospital Dept of Radiology
79-01 Broadway Room, A1-19
Elmhurst, NY 11373
Phone
(718) 334-2663
NPI assigned
May 22, 2007
Last updated
Jan 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R-7637 IA Primary

Addresses

Primary practice location

Mount Sinai Elmhurst Hospital Dept of Radiology
79-01 Broadway Room, A1-19
Elmhurst, NY 11373

Mailing address

1854 Sawnee Bean Rd
Thetford Center, VT 05075-8868
Phone (336) 462-9317

Other identifiers 1

IdentifierTypeStateIssuer
5913923MedicaidNC

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
I20240314001904 NY Practitioner - Diagnostic Radiology 2062546021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7901 Broadway
Elmhurst, NY 11373-1329

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-7637IAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Diagnostic Radiology CurrentSince Jan 15, 2024 Accepting new patients
Triad Radiology Associates, PLLC Past Accepting new patients

Locations

7901 Broadway
Rm A119
Elmhurst, NY 11373
Phone (718) 334-4951

Networks

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

Organizations & group practices 3

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": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1063621332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1854 SAWNEE BEAN RD",
            "city": "THETFORD CENTER",
            "state": "VT",
            "postal_code": "050758868",
            "telephone_number": "336-462-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MOUNT SINAI ELMHURST HOSPITAL DEPT OF RADIOLOGY",
            "address_2": "79-01 BROADWAY ROOM, A1-19",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "11373",
            "telephone_number": "718-334-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LLEWELLYN",
        "first_name": "KEVIN",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "R-7637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5913923",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, NY

Sources for this page

Verify at the official NPI Registry.