Individual provider Active NPI

Mikhal Ibragimov

  • Physician Assistant
  • Fresh Meadows, NY
National Provider Identifier
1225673908
Registry record updated Nov 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
7008 171St St
Fresh Meadows, NY 11365-3336
Phone
(347) 649-5242
NPI assigned
Nov 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2019

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 Primary

Addresses

Primary practice location

7008 171St St
Fresh Meadows, NY 11365-3336

Mailing address

7008 171St St
Fresh Meadows, NY 11365-3336

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
I20200417000190 NY Practitioner - Physician Assistant 1355771296 Reassigns benefits to 1 organization

National Provider Directory

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

Networks

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

Organizations & group practices 1

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": "1573948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573948800000",
    "number": "1225673908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7008 171ST ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113653336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7008 171ST ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113653336",
            "telephone_number": "347-649-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAGIMOV",
        "first_name": "MIKHAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-17",
        "last_updated": "2019-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresh Meadows, NY

Sources for this page

Verify at the official NPI Registry.