NPIMap

Individual provider Active NPI

Dmitriy Fuzaylov, MD

  • Pain Medicine (Anesthesiology) Physician
  • Rego Park, NY
National Provider Identifier
1093974040
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
241269 Issued in NY
Practice address
9701 66TH Ave
Rego Park, NY 11374-4245
Phone
(718) 275-5200
Fax
(718) 275-6864
NPI assigned
Jun 5, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 241269 NY
Pain Medicine (Anesthesiology) Physician 207LP2900X MD436995 PA
Pain Medicine (Anesthesiology) Physician 207LP2900X 241269 NY Primary

Addresses

Primary practice location

9701 66TH Ave
Rego Park, NY 11374-4245

Mailing address

9701 66TH Ave
Rego Park, NY 11374-4245
Phone (718) 275-5200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100812000134 NY Practitioner - Pain ManagementPractitioner - Physical Medicine and Rehabilitation 6406980572 Reassigns benefits to 1 organization
Practice locations: Rego Park, NY

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Physical Medicine and Rehabilitation
Education
Icahn School of Medicine at Mount Sinai, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Innovative Rehabilitation Consultant Medical PCGroup PAC ID 9739350695, 4 clinicians

Practice addresses (Care Compare)

9701 66TH Ave
Rego Park, NY 11374-4245
Phone (718) 275-5200

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD436995PAMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Innovation Spine Medical PC CurrentSince Dec 17, 2014 Accepting new patients
Innovative Rehabilitation Consultant Medical PC CurrentSince Aug 1, 2020 Accepting new patients
CHG Medical Care PC Physical Medicine & Rehabilitation PastSince Aug 1, 2020 Accepting new patients
CHC Chiropractic PC PastSince Oct 1, 2017 Accepting new patients

Locations

4 Weber Ave
Malverne, NY 11565
Phone (516) 599-3999

21429 Jamaica Ave
Queens Village, NY 11428
Phone (718) 465-4540

9701 66th Ave
Rego Park, NY 11374
Phone (718) 275-5200

Networks

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

Organizations & group practices 4

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 7

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": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1093974040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9701 66TH AVE",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744245",
            "telephone_number": "718-275-5200",
            "fax_number": "718-275-6864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 66TH AVE",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744245",
            "telephone_number": "718-275-5200",
            "fax_number": "718-275-6864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUZAYLOV",
        "first_name": "DMITRIY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-05",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "241269",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "PA",
            "license": "MD436995",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NY",
            "license": "241269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

Verify at the official NPI Registry.