Individual provider Active NPI

Izabella Yusupova, NP

  • Adult Health Nurse Practitioner
  • Jamaica, NY
National Provider Identifier
1235474131
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
306271 Issued in NY
Practice address
8268 164TH St
Jamaica, NY 11432-1121
Phone
(718) 883-3000
NPI assigned
Dec 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 306271 NY Primary

Addresses

Primary practice location

8268 164TH St
Jamaica, NY 11432-1121

Mailing address

8268 164TH St
Jamaica, NY 11432-1121
Phone (718) 883-3000

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
I20140822001244 NY Order and Referring Only - Nurse Practitioner 9335367911

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
306271NYMDHospice and Palliative Medicine (Internal Medicine) Physician

Networks

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

Interoperability endpoints

  • Direct secure messaging: izabella.yusupova.1@24989.direct.athenahealth.com
  • Direct secure messaging: iyusupova16371@nychhc.direct-ci.com

NPI Registry JSON

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

{
    "created_epoch": "1354492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1235474131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8268 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321121",
            "telephone_number": "718-883-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8268 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321121",
            "telephone_number": "718-883-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YUSUPOVA",
        "first_name": "IZABELLA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-03",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "306271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.