Individual provider Active NPI

Larisa Simkhaev, PA

  • Physician Assistant
  • Bronx, NY
National Provider Identifier
1215027180
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
007000 Issued in NY
Practice address
MMC - Dept. of Medicine
111 East 210TH Street
Bronx, NY 10467
Phone
(718) 920-2961
NPI assigned
Oct 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 007000 NY Primary

Addresses

Primary practice location

MMC - Dept. of Medicine
111 East 210TH Street
Bronx, NY 10467

Mailing address

6325 Saunders St
Apt. 2K
Rego Park, NY 11374-2034
Phone (718) 920-2961

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040512000471 NY Practitioner - Physician Assistant 9436148574 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Complete Neurological Care PCGroup PAC ID 9537320593, 14 clinicians
SJ All Medical PCGroup PAC ID 9830412642, 10 clinicians

Practice addresses (Care Compare)

112 47 Queens Boulevard
Suite 206
Forest Hills, NY 11375-7421
Phone (718) 544-4200

125 N Central Ave
Suite a
Valley Stream, NY 11580-3822
Phone (516) 887-8808

139 N Central Ave
Suite 2
Valley Stream, NY 11580-3859
Phone (516) 887-8808

150 E 55TH St
FL 4
New York, NY 10022-4514
Phone (212) 349-2787

225 Broadway
Suite 705
New York, NY 10007-3791
Phone (212) 349-2787

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Medical Practice P.C. Past Accepting new patients

Networks

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

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215027180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6325 SAUNDERS ST",
            "address_2": "APT. 2K",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742034",
            "telephone_number": "718-920-2961",
            "fax_number": "718-920-2058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MMC - DEPT. OF MEDICINE",
            "address_2": "111 EAST 210TH STREET",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10467",
            "telephone_number": "718-920-2961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMKHAEV",
        "first_name": "LARISA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "007000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.