Individual provider Active NPI

Rachel Khodadadian, M.D.

  • Pediatrics Physician
  • New York, NY
National Provider Identifier
1376847400
Registry record updated Dec 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
265833 Issued in NY
Practice address
357 E 57TH St
Apt 8D
New York, NY 10022-2907
Phone
(646) 701-0040
NPI assigned
Jan 4, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 265833 NY Primary

Addresses

Primary practice location

357 E 57TH St
Apt 8D
New York, NY 10022-2907

Mailing address

357 E 57TH St
Apt 8D
New York, NY 10022-2907

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
I20140403000189 NY Practitioner - Pediatric Medicine 1456582527 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
265833NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Sep 6, 2022 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 6, 2022 Accepting new patients
Prohealth Care Associates LLP Pediatrics Past Accepting new patients
Mount Kisco Medical Group Past Accepting new patients

Locations

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

Philadelphia, PA 19195

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.

NPI Registry JSON

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

{
    "created_epoch": "1294099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387411200000",
    "number": "1376847400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 E 57TH ST",
            "address_2": "APT 8D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100222907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 E 57TH ST",
            "address_2": "APT 8D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100222907",
            "telephone_number": "646-701-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHODADADIAN",
        "first_name": "RACHEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-04",
        "last_updated": "2013-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "265833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.