Keisha Nerissa Benjamin, M.D.
Individual provider Active NPI Anesthesiology Physician · Queens, NY
NPI 1154596930 · NPPES record last updated Oct 21, 2019
Key facts
- NPI
- 1154596930
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 266608 (NY)
- Practice address
- 56-45 Main Street
Queens, NY 11355-2056 - Phone
- (718) 670-2000
- NPI assigned
- Apr 23, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- Michigan State University College of Human Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physician Affiliate Group of New York PC
Practice addresses (Care Compare)
506 Lenox Ave
New York, NY 10037-1802
Phone (212) 939-1840
Hospital & facility affiliations
- Harlem Hospital Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130413000092 | NY | Practitioner - Anesthesiology | 9931345162 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 266608 | NY | MD | Anesthesiology Physician |
Practice roles (2 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Affiliate Group of New York PC | Single Specialty | Current |
Accepting new patients |
| Harlem Medical Associates PC | Single Specialty | Current |
Accepting new patients |
Locations
2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354
506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000
45 Research Way
Ste 206
Setauket, NY 11733
Phone (631) 575-9300
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Anesthesiology Physician |
207L00000X | 266608 | NY | Yes |
Addresses
Primary practice location
56-45 Main Street
Queens, NY 11355-2056
Mailing address
890 Brooklyn Ave Apt 2F
Brooklyn, NY 11203-2838
Phone (734) 330-3398
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All providers in Queens, NY · Anesthesiology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.