NPIMap

Individual provider Active NPI

Simkha Khavasov, CRNA

  • Certified Registered Nurse Anesthetist
  • Bronx, NY
National Provider Identifier
1174135800
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
703765 Issued in NY
Practice address
111 E 210TH St
Bronx, NY 10467-2401
Phone
(718) 920-4316
NPI assigned
Aug 24, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 703765 NY Primary

Addresses

Primary practice location

111 E 210TH St
Bronx, NY 10467-2401

Mailing address

111 E 210TH St
Bronx, NY 10467-2401
Phone (718) 920-4316

Other practice location 1

170 William St
New York, NY 10038-2612
Phone (212) 746-2962

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210616002425 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 1850791575 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York Cardiovascular Anesthesiologists, P.C.Group PAC ID 5799676623, 135 clinicians

Practice addresses (Care Compare)

1000 Montauk Hwy
West Islip, NY 11795-4927
Phone (516) 627-6624

622 W 168TH St
New York, NY 10032-3720
Phone (212) 305-9876

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

Merit-based Incentive Payment System (MIPS)

Final score
94.24 of 100Reported as group
Quality
98.74
Improvement activities
40
Cost
83.11

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Oct 15, 2021 Accepting new patients
North American Partners in Anesthesia LLP CurrentSince May 15, 2021 Accepting new patients
New York University Current Accepting new patients
New York Cardiovascular Anesthesiologists, P.C. CurrentSince Dec 18, 2021 Accepting new patients
Montefiore Medical Center CurrentSince Oct 15, 2021 Accepting new patients
Jamaica Anesthesiologist, PC CurrentSince Jun 13, 2022 Accepting new patients
Long Island Anesthesia Physicians LLP CurrentSince Sep 28, 2021 Accepting new patients
Weill Medical College of Cornell CurrentSince Feb 2, 2022 Accepting new patients
New York University CurrentSince Feb 1, 2024 Accepting new patients
New York University CurrentSince Feb 1, 2024 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Feb 1, 2024 Accepting new patients
Weill Medical College of Cornell Nurse Anesthetist, Certified Registered CurrentSince Feb 2, 2022 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Feb 1, 2024 Accepting new patients

Locations

7 Southwoods Blvd
Ste 4
Albany, NY 12211

111 E 210th St
Bronx, NY 10467

5645 Main St
Flushing, NY 11355
Phone (718) 670-1435

3122 Union St
Ste 1B
Flushing, NY 11354
Phone (718) 968-7171

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

1510 Jericho Tpke
New Hyde Park, NY 11040
Phone (516) 216-5341

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

530 1st Ave
New York, NY 10016
Phone (212) 263-7216

156 William St
New York, NY 10038
Phone (646) 962-4679

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

170 William St
New York, NY 10038
Phone (212) 238-0100

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

101 Hospital Rd
Patchogue, NY 11772
Phone (631) 654-7100

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

8900 Van Wyck Expy
Richmond Hill, NY 11418
Phone (718) 206-6088

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

1500 William Floyd Pkwy
Shirley, NY 11967
Phone (631) 205-0800

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 9

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": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643760000000",
    "number": "1174135800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-920-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-920-4316"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "170 William St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100382612",
            "country_code": "US",
            "telephone_number": "212-746-2962",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAVASOV",
        "first_name": "SIMKHA",
        "name_prefix": "Dr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-24",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "703765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.