Individual provider Active NPI

Levan Khasidy, MD

  • Urology Physician
  • Forest Hills, NY
National Provider Identifier
1073607727
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
160993 Issued in NY
Practice address
11115 Queens Blvd
2ND FL
Forest Hills, NY 11375-7422
Phone
(718) 520-2300
Fax
(718) 520-4440
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 160993 NY Primary

Addresses

Primary practice location

11115 Queens Blvd
2ND FL
Forest Hills, NY 11375-7422

Mailing address

111-15 Queens Blvd
2ND FL
Forest Hills, NY 11375-7422
Phone (718) 520-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040903001123 NY Practitioner - Urology 7416932413 Reassigns benefits to 3 organizations
Practice locations: Brooklyn, NY
I20260225004475 FL Practitioner - Urology 7416932413 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11115 Queens Blvd
Forest Hills, NY 11375-7422
Phone (718) 520-2300

4035 95TH St
Elmhurst, NY 11373-6206
Phone (718) 520-2300

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Elite 23 Holding Group LLC CurrentSince Feb 15, 2026 Accepting new patients
Michael Z Weiner MDPC Past Accepting new patients
Suny Downstate Medical Center Past Accepting new patients
Century Medical & Dental Center Inc PastSince Dec 18, 2002 Accepting new patients
SVS Wellcare Medical PLLC Past Accepting new patients
Provider Medical Care PC Past Accepting new patients

Locations

202 Sunny Isles Blvd
Ste 8A
Sunny Isles Beach, FL 33160
Phone (305) 523-9787

Networks

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

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215993600000",
    "number": "1073607727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111-15 QUEENS BLVD",
            "address_2": "2ND FL",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757422",
            "telephone_number": "718-520-2300",
            "fax_number": "718-520-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11115 QUEENS BLVD",
            "address_2": "2ND FL",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757422",
            "telephone_number": "718-520-2300",
            "fax_number": "718-520-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHASIDY",
        "first_name": "LEVAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "160993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.