Ketevan Berekashvili, MD

Primary specialty

Vascular Neurology PhysicianTaxonomy code 2084V0102X

License

286750 Issued in NY

Practice address

211 61St St Apt 1
Brooklyn, NY 11220-3782

Phone

(718) 630-1270

Fax

(201) 387-1036

NPI assigned

Apr 20, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, NJ2 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

Specialty

Neurology

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MVHS IncGroup PAC ID 2769380252, 330 clinicians

Physician Affiliate Group of New York PCGroup PAC ID 4688098833, 1,222 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wynn Hospital Hospital, Utica, NY, CCN 330044
• South Brooklyn Health Hospital, Brooklyn, NY, CCN 330196

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: kberekashvili3514187@nychhc.direct-ci.com
• Direct secure messaging: kberekashvili47713@mvhealthsystem.direct-ci.com

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.

• MVHS Inc

  • Family Medicine Physician
  • Utica, NY
  • NPI 1770690737
  Medicare reassignment Care Compare group NPD
• Physician Affiliate Group of New York PC

  • Registered Dietitian
  • New York, NY
  • NPI 1013375526
  Medicare reassignment Care Compare group NPD
• Coney Island Medical Practice Plan, P.C.

  • General Practice Physician
  • Brooklyn, NY
  • NPI 1386951762
  Medicare reassignment NPD
• Jeffrey Farkas MD LLC

  • Vascular & Interventional Radiology Physician
  • East Hills, NY
  • NPI 1114267929

  NJ

  Medicare reassignment NPD
• MVHS Inc

  • Community/Retail Pharmacy
  • Utica, NY
  • NPI 1306573753
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• MVHS Inc

  • General Acute Care Hospital
  • Utica, NY
  • NPI 1205877172
  Care Compare affiliation
• New York City Health and Hospitals Corporation

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1124032982
  Care Compare affiliation

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

{
    "created_epoch": "1334880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552521600000",
    "number": "1114284734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 61 STREET",
            "address_2": "APT 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11220",
            "telephone_number": "718-630-1270",
            "fax_number": "201-387-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 61ST ST APT 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203782",
            "telephone_number": "718-630-1270",
            "fax_number": "201-387-1036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Northern Blvd Ste 207",
            "address_purpose": "LOCATION",
            "city": "Greenvale",
            "state": "NY",
            "postal_code": "115481220",
            "country_code": "US",
            "telephone_number": "516-466-1029",
            "fax_number": "201-387-1036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEREKASHVILI",
        "first_name": "KETEVAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-20",
        "last_updated": "2019-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NY",
            "license": "286750",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "286750",
            "primary": false
        },
        {
            "code": "2084V0102X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Vascular Neurology",
            "state": "NY",
            "license": "286750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asher Bercow
• Sabine Bercy, RPA-C
• Natalia Berdichevskiy
• Elie Berdy, LCSW
• Polina Berek, PA-C
• Ruth Berelowitz
• Susan E Beren, PHD
• Alexander Berenblit, MD
• Britny Elizabeth Berends
• Lisa Berenholz

• Vascular Neurology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Vascular Neurology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.