Individual provider Active NPI

Lidiya Shestoperova, P.A.

  • Physician Assistant
  • Staten Island, NY
National Provider Identifier
1255575312
Registry record updated Apr 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
013225 Issued in NY
Practice address
71 Cedarview Ave
Staten Island, NY 10306-2048
Phone
(347) 251-2099
NPI assigned
Apr 20, 2009
Last updated
Apr 20, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2009

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 013225 NY Primary

Addresses

Primary practice location

71 Cedarview Ave
Staten Island, NY 10306-2048

Mailing address

71 Cedarview Ave
Staten Island, NY 10306-2048
Phone (347) 251-2099

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
I20091027000517 NY Practitioner - Physician Assistant 1456498203 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1305 Kings Hwy
Brooklyn, NY 11229-1903
Phone (718) 280-5172

2175 86TH St
Brooklyn, NY 11214-3205
Phone (646) 828-6401

2187 Richmond Ave
Staten Island, NY 10314-3920
Phone (646) 682-7364

2710 Hylan Blvd
Staten Island, NY 10306-4658
Phone (718) 489-3551

336 E 86TH St
New York, NY 10028-4615
Phone (212) 772-3627

5024 5TH Ave
Brooklyn, NY 11220-1909
Phone (718) 571-9251

5788 -5800 Amboy Rd
Staten Island, NY 10309-3137
Phone (718) 571-9716

6502 18TH Ave
Brooklyn, NY 11204-3702
Phone (718) 571-9423

812 Forest Ave
Staten Island, NY 10310-2446
Phone (718) 571-9196

8712 4TH Ave
Brooklyn, NY 11209-5110
Phone (718) 530-1155

Merit-based Incentive Payment System (MIPS)

Final score
86.33 of 100Reported as group
Quality
82.1
Promoting interoperability
100
Improvement activities
40
Cost
72.34

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Sep 1, 2009 Accepting new patients
Montefiore Medical Center CurrentSince Sep 1, 2009 Accepting new patients
Physicians of University Hospital, PC CurrentSince Dec 14, 2015 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Dec 15, 2016 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Dec 15, 2016 Accepting new patients

Locations

3111 Steinway St
Astoria, NY 11103
Phone (718) 475-2345

111 E 210th St
Bronx, NY 10467

336 E 86th St
New York, NY 10028
Phone (212) 772-3627

242 Mason Ave
Staten Island, NY 10305
Phone (718) 226-1458

1345 Rxr Plz
Uniondale, NY 11556
Phone (516) 453-0435

Networks

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

Interoperability endpoints

  • Direct secure messaging: lidiya.shestoperova.1@2983.direct.athenahealth.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240185600000",
    "number": "1255575312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 CEDARVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103062048",
            "telephone_number": "347-251-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 CEDARVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103062048",
            "telephone_number": "347-251-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHESTOPEROVA",
        "first_name": "LIDIYA",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-20",
        "last_updated": "2009-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.