Individual provider Active NPI

Alexandra Livanos, MD, PHD

  • Gastroenterology Physician
  • New York, NY
National Provider Identifier
1184019424
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
292587 Issued in NY
Practice address
17 E 102ND St
New York, NY 10029-5204
Phone
(212) 241-8100
Fax
(646) 537-8921
NPI assigned
Apr 3, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Gastroenterology Physician 207RG0100X 292587 NY Primary

Addresses

Primary practice location

17 E 102ND St
New York, NY 10029-5204

Mailing address

1 Gustave L Levy PL # 1118
New York, NY 10029-6504
Phone (212) 241-0896

Other practice location 1

622 W 168th St # 205
New York, NY 10032-3720
Phone (212) 305-6354

Other practice location 2

1 Gustave L Levy Pl
New York, NY 10029-6504
Phone (212) 241-8100

Other practice location 3

1184 5th Ave
New York, NY 10029-6503
Phone (212) 659-8770

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220520000964 NY Practitioner - Gastroenterology 2163809757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
New York University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

17 E 102ND St
New York, NY 10029-5204
Phone (212) 861-2000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy15
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
292587NYMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Gastroenterology CurrentSince Jul 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jul 1, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

17 E 102nd St
New York, NY 10029
Phone (212) 241-7968

1111 Amsterdam Ave
New York, NY 10025
Phone (212) 523-2309

1184 5th Ave
New York, NY 10029
Phone (212) 241-7500

Networks

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

Organizations & group practices 3

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 8

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": "1428019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1184019424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL # 1118",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296504",
            "telephone_number": "212-241-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 E 102ND ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100295204",
            "telephone_number": "212-241-8100",
            "fax_number": "646-537-8921"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "622 W 168th St # 205",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323720",
            "country_code": "US",
            "telephone_number": "212-305-6354",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Gustave L Levy Pl",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296504",
            "country_code": "US",
            "telephone_number": "212-241-8100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1184 5th Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296503",
            "country_code": "US",
            "telephone_number": "212-659-8770",
            "fax_number": "212-241-7917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIVANOS",
        "first_name": "ALEXANDRA",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-03",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "292587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.