Individual provider Active NPI

Xing Peng, MD

  • Diagnostic Radiology Physician
  • Brooklyn, NY
National Provider Identifier
1275558470
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
220809 Issued in NY
Practice address
150 55TH St
Brooklyn, NY 11220-2559
Phone
(718) 630-7402
Fax
(718) 630-8857
NPI assigned
Jul 12, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 220809 NY Primary

Addresses

Primary practice location

150 55TH St
Brooklyn, NY 11220-2559

Mailing address

62 Stone Hill Dr S
Manhasset, NY 11030-4426
Phone (718) 630-7402

Other identifiers 1

IdentifierTypeStateIssuer
02144829MedicaidNY

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
I20231010002032 NY Order and Referring Only - Interventional RadiologyPractitioner - Interventional Radiology 5799684981

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
220809NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sunset Park Radiology PC Diagnostic Radiology Current Accepting new patients
Trustees of Columbia University in the City of New York Diagnostic Radiology Past Accepting new patients
Victoria Physical Medicine PC PastSince Nov 1, 2004 Accepting new patients
Brooklyn Radiology Services PC Diagnostic Radiology PastSince Jun 1, 2011 Accepting new patients
Shore Road Radiology Associates, PC Diagnostic Radiology Past Accepting new patients

Networks

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

Organizations & group practices 5

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275558470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 STONE HILL DR S",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110304426",
            "telephone_number": "718-630-7402",
            "fax_number": "718-630-8857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 55TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112202559",
            "telephone_number": "718-630-7402",
            "fax_number": "718-630-8857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENG",
        "first_name": "XING",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "220809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02144829",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.