Individual provider Active NPI

Menatallah Ihab Elkoush, DO

  • Family Medicine Physician
  • Liverpool, NY
National Provider Identifier
1396312229
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
331636 Issued in NY
Practice address
4820 W Taft Rd Ste 108
Liverpool, NY 13088-4865
Phone
(315) 413-0004
Fax
(315) 413-0827
NPI assigned
Jun 9, 2021
Last updated
Jul 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 331636 NY Primary

Addresses

Primary practice location

4820 W Taft Rd Ste 108
Liverpool, NY 13088-4865

Mailing address

1001 W Fayette St Ste 400
Syracuse, NY 13204-2866
Phone (315) 937-3026

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
I20240910000747 NY Practitioner - Family Practice 7911300686 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Familycare Medical Group PCGroup PAC ID 5193639565, 110 clinicians

Practice addresses (Care Compare)

4820 W Taft Rd
Suite 108
Liverpool, NY 13088-4865
Phone (315) 413-0004

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
331636NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Syracuse Community Health Center CurrentSince Sep 1, 2024 Accepting new patients
Familycare Medical Group, PC Family Medicine CurrentSince Jul 1, 2025 Accepting new patients
Syracuse Community Health Center, Inc. CurrentSince Sep 1, 2024 Accepting new patients

Locations

4820 W Taft Rd
Ste 108
Liverpool, NY 13088
Phone (315) 413-0004

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

819 S Salina St
Syracuse, NY 13202

930 S Salina St
Syracuse, NY 13202
Phone (315) 234-5960

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: melkoush@fcmg.medentdirect.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1396312229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST STE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042866",
            "telephone_number": "315-937-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4820 W TAFT RD STE 108",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130884865",
            "telephone_number": "315-413-0004",
            "fax_number": "315-413-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELKOUSH",
        "first_name": "MENATALLAH",
        "middle_name": "IHAB",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-09",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "331636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.