Amin Fazeli, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

236051 Issued in NY

Practice address

4110 Medical Center Dr
Suite 110
Fayetteville, NY 13066-6613

Phone

(315) 663-0100

Fax

(585) 663-0052

NPI assigned

Apr 17, 2006

Last updated

Jan 26, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Dermatology

Education

Yale University School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr. Fazeli and Dr. Broumand LLCGroup PAC ID 0446358063, 11 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Fazeli & Dr. Broumand LLC

  • Dermatology Physician
  • Fayetteville, NY
  • NPI 1336235639
  Medicare reassignment Care Compare group Authorized official
• Dermatology Associates of Rochester, PC

  • Specialist
  • Rochester, NY
  • NPI 1174632285
  NPD (past)
• Dermatology Associates of Naples LLC

  • Specialist
  • Bonita Springs, FL
  • NPI 1851400949

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485388800000",
    "number": "1215991005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 MEDICAL CENTER DR",
            "address_2": "DERMATOLOGY ASSOCIATES OF CNY PLLC",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666613",
            "telephone_number": "315-663-0100",
            "fax_number": "315-663-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 MEDICAL CENTER DR",
            "address_2": "SUITE 110",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666613",
            "telephone_number": "315-663-0100",
            "fax_number": "585-663-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZELI",
        "first_name": "AMIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2017-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "236051",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "236051",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RA7948",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Lou Farchione, MD
• Fateh Supply Inc
• Fayetteville Dental Associates
• Fayetteville Family Dentistry
• Fayetteville Family Physician, PLLC
• Samantha Hannah Fehr
• Robert Feldman, MD
• Andrew L Finley, MD
• Firefly Therapy Services
• Steven Fishel

• Dermatology Physician in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; 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.
• 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.