NPIMap

Individual provider Active NPI

Gustavo Barraza, MD

  • General Practice Physician
  • New York, NY
National Provider Identifier
1396437224
Registry record updated Jul 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
60-P121345-01 Issued in NY
Practice address
1275 York Ave
New York, NY 10065-6007
Phone
(347) 798-9213
NPI assigned
May 19, 2023
Last updated
Jul 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 60-P121345-01 NY Primary

Addresses

Primary practice location

1275 York Ave
New York, NY 10065-6007

Mailing address

250 E 77TH St Apt 2D
New York, NY 10075-2199
Phone (914) 885-6767

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250725000994 NY Practitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 2567979594 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Nuclear Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mskcc Radiology GroupGroup PAC ID 3971494683, 192 clinicians
Memorial Nuclear Medicine GroupGroup PAC ID 9638068067, 37 clinicians

Practice addresses (Care Compare)

1101 Hempstead Tpke
Uniondale, NY 11553-1112
Phone (516) 559-1000

1275 York Ave
New York, NY 10065-6007
Phone (212) 639-2000

160 E 53Rd St
New York, NY 10022-5243
Phone (212) 610-0496

300 E 66TH St
New York, NY 10065-6800
Phone (646) 888-5300

500 Westchester Ave
West Harrison, NY 10604-3200
Phone (914) 367-7105

650 Commack Rd
Commack, NY 11725-5404
Phone (631) 623-4300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60-P121345-01NYMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Nuclear Medicine Group CurrentSince May 12, 2025 Accepting new patients
Mskcc Radiology Group CurrentSince May 12, 2025 Accepting new patients

Locations

1275 York Ave
New York, NY 10065
Phone (212) 639-3813

633 3rd Ave
Fl 4
New York, NY 10017
Phone (646) 227-3764

Networks

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

Organizations & group practices 2

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 11

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": "1684454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720828800000",
    "number": "1396437224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E 77TH ST APT 2D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100752199",
            "telephone_number": "914-885-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100656007",
            "telephone_number": "347-798-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARRAZA",
        "first_name": "GUSTAVO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-19",
        "last_updated": "2024-07-13",
        "certification_date": "2024-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "60-P121345-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.