Individual provider Active NPI

Angel G Premkumar, MD

  • Diagnostic Radiology Physician
  • Flushing, NY
National Provider Identifier
1245298108
Registry record updated Feb 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
219739 Issued in NY
Practice address
4500 Parsons Blvd
Flushing, NY 11355
Phone
(718) 670-5447
Fax
(718) 670-3039
NPI assigned
May 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 219739 NY Primary

Addresses

Primary practice location

4500 Parsons Blvd
Flushing, NY 11355

Mailing address

80 Marcus Dr
Provider Enrollment
Melville, NY 11747-4230
Phone (631) 391-7887

Other identifiers 1

IdentifierTypeStateIssuer
02735399MedicaidNY

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
I20060315000321 NY Practitioner - Diagnostic Radiology 8224045349 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
State University of New York Downstate Medical Center, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jamaica HospitalGroup PAC ID 2264324334, 252 clinicians
TJH Medical Services PCGroup PAC ID 8527960533, 215 clinicians

Practice addresses (Care Compare)

13303 Jamaica Ave
Richmond Hill, NY 11418-2618
Phone (718) 291-3276

17660 Union Tpke
Suite 100
Fresh Meadows, NY 11366-1531
Phone (718) 408-6977

4500 Parsons Blvd
Flushing, NY 11355-2205
Phone (718) 670-5447

8900 Van Wyck Expy
Jamaica, NY 11418-2832
Phone (718) 206-6000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jamaica Hospital CurrentSince Jan 1, 2006 Accepting new patients
TJH Medical Services, P.C. CurrentSince May 4, 2021 Accepting new patients
Jamaica Hospital CurrentSince Jan 1, 2006 Accepting new patients

Locations

4500 Parsons Blvd
Flushing, NY 11355
Phone (718) 670-5631

17660 Union Tpke
Ste 100
Fresh Meadows, NY 11366
Phone (718) 408-6977

11940 Metropolitan Ave
Kew Gardens, NY 11415
Phone (718) 849-0839

80 Marcus Dr
Melville, NY 11747
Phone (631) 391-7889

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

8900 Van Wyck Expy
Richmond Hill, NY 11418
Phone (718) 206-6088

Networks

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

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.

Hospital & facility affiliations 3

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": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359676800000",
    "number": "1245298108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 MARCUS DR",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117474230",
            "telephone_number": "631-391-7887",
            "fax_number": "631-454-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 PARSONS BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11355",
            "telephone_number": "718-670-5447",
            "fax_number": "718-670-3039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREMKUMAR",
        "first_name": "ANGEL",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2013-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "219739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02735399",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.