Nikolai Klebanov, MD

Key facts

NPI

1386202158

Entity type

Individual (NPI type 1)

Primary specialty

Dermatology Physician 207N00000X

License

1014901 (MA)

Practice address

900 Cummings Ctr Ste 311T
Beverly, MA 01915-6260

Phone

(978) 225-3376

Fax

(978) 560-1245

NPI assigned

Jun 5, 2019

Sex

Male

Sole proprietor

No

Organizations & group practices 7

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.

• Lahey Clinic, Inc Internal Medicine Physician · Peabody, MA · NPI 1063447316
  Medicare reassignment Care Compare group NPD MA
• Lahey Clinic, Inc. Internal Medicine Physician · Burlington, MA · NPI 1538194980
  Medicare reassignment Care Compare group NPD MA
• Massachusetts Dermatology Associates, P.C. Dermatology Physician · Beverly, MA · NPI 1396167763
  Medicare reassignment Care Compare group NPD DERMATOLOGY · MA
• Massderm Billing PC Dermatology Physician · Beverly, MA · NPI 1033655667
  Medicare reassignment Care Compare group NPD DERMATOLOGY · MA
• Beth Israel Lahey Health Primary Care Inc Clinic/Center · Middleboro, MA · NPI 1568292423
  Medicare reassignment MA
• Lahey Clinic, Inc. Internal Medicine Physician · Derry, NH · NPI 1669491601
  Care Compare group
• Beth Israel Lahey Health Primary Care, Inc. Urgent Care Clinic/Center · Lynnfield, MA · NPI 1922505072
  NPD

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lahey Clinic Hospital, Inc. General Acute Care Hospital · Burlington, MA · NPI 1558392563
  Care Compare affiliation Hospital
• North Shore Medical Center, Inc. General Acute Care Hospital · Salem, MA · NPI 1730121633
  Care Compare affiliation Hospital
• Northeast Hospital Corporation General Acute Care Hospital · Beverly, MA · NPI 1316917941
  Care Compare affiliation Hospital
• Northeast Hospital Corporation Psychiatric Hospital Unit · Beverly, MA · NPI 1407827710
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Dermatology

Education

Tufts University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lahey Clinic Inc (1,381 clinicians)
Massderm Billing PC (14 clinicians)
Massachusetts Dermatology Associates, P.C. (15 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lahey Hospital & Medical Center, Burlington Hospital · Burlington, MA · CCN 220171
• North Shore Medical Center - Hospital · Salem, MA · CCN 220035
• Northeast Hospital Corporation Hospital · Beverly, MA · CCN 220033

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nklebanov117771@direct.bilh.masshiway.net
• Direct secure messaging: klebanov.nikolai.mda@direct.partners.masshiway.net
• Direct secure messaging: derm@mda.emadirect.md

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 17, 2024.

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1386202158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 CENTRE ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023308",
            "telephone_number": "508-941-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CUMMINGS CTR STE 311T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156260",
            "telephone_number": "978-225-3376",
            "fax_number": "978-560-1245"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 Centre St",
            "address_purpose": "LOCATION",
            "city": "Brockton",
            "state": "MA",
            "postal_code": "023023308",
            "country_code": "US",
            "telephone_number": "508-941-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "41 Mall Road",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "MA",
            "postal_code": "018053308",
            "country_code": "US",
            "telephone_number": "781-744-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLEBANOV",
        "first_name": "NIKOLAI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-05",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MA",
            "license": "1014901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "derm@mda.emadirect.md",
            "affiliation": "N",
            "endpointDescription": "Secure direct mail to MD at Massachusetts Dermatology Associates",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "900 Cummings Ctr Ste 311T",
            "city": "Beverly",
            "state": "MA",
            "country_code": "US",
            "postal_code": "019156260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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All providers in Beverly, MA · Dermatology Physician in Massachusetts