Irondequoit Internal Medicine

Primary specialty

SpecialistTaxonomy code 174400000X

License

180528 Issued in NY

Legal business name

IRONDEQUOIT INTERNAL MEDICINE

Practice address

485 Titus Ave Ste H
Rochester, NY 14617-3544

Phone

(585) 338-2530

Fax

(585) 338-7304

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Larisa Khishchenko, M.D.NPI 1851321855

Title

Owner

Phone

(585) 338-2530

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Larisa Khishchenko, M.D.

  • Internal Medicine Physician
  • Rochester, NY
  • NPI 1851321855

  Specialist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245375708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 TITUS AVE STE H",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146173544",
            "telephone_number": "585-338-2530",
            "fax_number": "585-338-7304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 TITUS AVE STE H",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146173544",
            "telephone_number": "585-338-2530",
            "fax_number": "585-338-7304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRONDEQUOIT INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KHISHCHENKO",
        "authorized_official_first_name": "LARISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "585-338-2530",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "180528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "102621BJ",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01584647",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Uzma Iqbal, MD
• Irie Transportation Associated
• Irondequoit Ambulance Inc
• Irondequoit Chiropractic, PLLC
• Irondequoit General Surgery, LLC
• Irondequoit Pediatrics
• Irondequoit Pediatrics, PLLC
• Irondequoit Pharmacy, LLC
• Natalie Shakera Irvin
• Tracie Celeste Irvin, LPN

• Specialist in Rochester, NY
• Providers in Rochester, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.