NPIMap

Individual provider Active NPI

Mazen Elyan, MD

  • Rheumatology Physician
  • Crestview Hills, KY
National Provider Identifier
1104978048
Registry record updated Apr 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
52243 Issued in KY
Practice address
651 Centre View Boulevard
Crestview Hills, KY 41017-5419
Phone
(859) 344-1900
Fax
(859) 344-4632
NPI assigned
Jan 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 35085724 OH
Rheumatology Physician 207RR0500X 01072711A IN
Rheumatology Physician 207RR0500X 52243 KY Primary

Addresses

Primary practice location

651 Centre View Boulevard
Crestview Hills, KY 41017-5419

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 344-1900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131021001763 IN Practitioner - RheumatologyPractitioner - Internal Medicine 3173621620 Reassigns benefits to 2 organizations
I20190718003643 KY Practitioner - Rheumatology 3173621620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
RheumatologyAlso: Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, shared by 11 NPIs, 803 clinicians

Practice addresses (Care Compare)

1640 Flossie Dr
Greendale, IN 47025-8424
Phone (855) 277-4230

651 Centre View Boulvard
Crestview Hills, KY 41017-5419
Phone (859) 331-6466

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52243KYMDRheumatology Physician
35085724OHMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Diagnostic Associates, Inc. Rheumatology CurrentSince Jan 1, 2017 Accepting new patients
Summit Medical Group, Inc Current Accepting new patients
Summit Medical Group, Inc. CurrentSince Jun 28, 2019 Accepting new patients
Summit Medical Group, Inc CurrentSince Jun 28, 2019 Accepting new patients
Major Hospital Past Accepting new patients

Locations

7301 Solutions Ctr
Chicago, IL 60677

204 Bridgeway St
Aurora, IN 47001
Phone (812) 926-3133

550 University Blvd
Indianapolis, IN 46202
Phone (217) 274-5000

1640 Flossie Dr
Lawrenceburg, IN 47025
Phone (812) 496-3285

651 Centre View Blvd
Crestview Hills, KY 41017
Phone (859) 341-6660

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Interoperability endpoints

  • Direct secure messaging: melyan288149@direct-prd.stelizabeth.com

Organizations & group practices 5

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 4

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": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556236800000",
    "number": "1104978048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-344-1900",
            "fax_number": "859-344-4632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 CENTRE VIEW BOULEVARD",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410175419",
            "telephone_number": "859-344-1900",
            "fax_number": "859-344-4632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELYAN",
        "first_name": "MAZEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2019-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "OH",
            "license": "35085724",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "IN",
            "license": "01072711A",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "KY",
            "license": "52243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview Hills, KY

Sources for this page

Verify at the official NPI Registry.