Renat Khasanov, MSN, PMHNP-BC, RN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

404349 Issued in NY

Practice address

75-59 263Rd Street
Glen Oaks, NY 11004-1100

Phone

(718) 470-5750

NPI assigned

Aug 14, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

Practice roles

Locations

Networks

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

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.

• North Shore-Lij Medical PC

  dba NHPP Cardiology at Great Neck

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572

  Single Specialty

  Medicare reassignment NPD
• North Shore - Lij Medical PC

  dba NSLIJ Medical In Queens

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD

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

{
    "created_epoch": "1660435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1174251318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2266 BATH AVE # 3010",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112145714",
            "telephone_number": "917-969-6012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75-59 263RD STREET",
            "city": "GLEN OAKS",
            "state": "NY",
            "postal_code": "110041100",
            "telephone_number": "718-470-5750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "451 Clarkson Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112032054",
            "country_code": "US",
            "telephone_number": "917-969-6012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHASANOV",
        "first_name": "RENAT",
        "credential": "MSN, PMHNP-BC, RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-14",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harmandeep Kaur
• Jaspal Kaur
• Navneet Kaur
• Rajinder Kaur
• Victor Pelumi Kekere, MD
• Maryam Kheirabi, PHARMD
• Alfrida Khokher
• Dave Sungsoo Kim, M.D.
• Jimmy Kim, PSYD
• Yongha Kim, MD

• Psychiatric/Mental Health Nurse Practitioner in Glen Oaks, NY
• Providers in Glen Oaks, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.