Individual provider Active NPI

Ian Charles Lord I, PA

  • Surgical Physician Assistant
  • New York, NY
National Provider Identifier
1275671323
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
009863 Issued in NY
Practice address
506 Malcolm X Blvd
New York, NY 10037-1802
Phone
(212) 989-4680
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
Yes

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
Surgical Physician Assistant 363AS0400X 009863 NY Primary

Addresses

Primary practice location

506 Malcolm X Blvd
New York, NY 10037-1802

Mailing address

277 Millbrook Ave
Randolph, NJ 07869-2105
Phone (973) 607-1739

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
I20101207000124 NY Practitioner - Physician Assistant 9739376575 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2510 30TH Ave
Astoria, NY 11102-2448
Phone (718) 932-1000

2520 30TH Ave
Astoria, NY 11102-2448
Phone (718) 808-7777

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
009863NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jan 31, 2023 Accepting new patients
The Mount Sinai Hospital CurrentSince Jan 7, 2019 Accepting new patients
Mount Sinai Hospital CurrentSince Jan 7, 2019 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 1, 2025 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 1, 2025 Accepting new patients
Montefiore Medical Center CurrentSince Jan 31, 2023 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

2715 30th Ave
Long Island City, NY 11102
Phone (718) 267-4808

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

150 E 42nd St
New York, NY 10017
Phone (212) 661-8139

10114 Liberty Ave
#13292
Ozone Park, NY 11417
Phone (718) 487-3330

Networks

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

Organizations & group practices 8

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 6

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": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275671323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 MILLBROOK AVE",
            "city": "RANDOLPH",
            "state": "NJ",
            "postal_code": "078692105",
            "telephone_number": "973-607-1739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 MALCOLM X BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100371802",
            "telephone_number": "212-989-4680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LORD",
        "first_name": "IAN",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "009863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.