NPIMap

Individual provider Active NPI

Kenji Ikemura, MD

  • Clinical Informatics (Pathology) Physician
  • New York, NY
National Provider Identifier
1457857617
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Informatics (Pathology) PhysicianTaxonomy code 207ZC0008X
License
314673-01 Issued in NY
Practice address
1300 York Ave
New York, NY 10065-4805
Phone
(949) 370-3777
NPI assigned
Apr 4, 2018
Last updated
Aug 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 314673-01 NY
Clinical Informatics (Pathology) Physician 207ZC0008X 314673-01 NY Primary

Addresses

Primary practice location

1300 York Ave
New York, NY 10065-4805

Mailing address

1300 York Ave
New York, NY 10065-4805
Phone (949) 370-3777

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
I20240815001960 NY Practitioner - Pathology 8426397357 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

170 William St
New York, NY 10038-2612
Phone (212) 312-5000

525 E 68TH St
New York, NY 10065-4870

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
314673-01NYMDClinical Informatics (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Weill Medical College of Cornell Multi-Specialty Current Accepting new patients
Weill Medical College of Cornell Multi-Specialty CurrentSince Jul 1, 2024 Accepting new patients
Weill Medical College of Cornell Multi-Specialty CurrentSince Jul 1, 2024 Accepting new patients

Locations

1300 York Ave
New York, NY 10065
Phone (212) 746-2900

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1457857617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654805",
            "telephone_number": "949-370-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100654805",
            "telephone_number": "949-370-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IKEMURA",
        "first_name": "KENJI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-04",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NY",
            "license": "314673-01",
            "primary": false
        },
        {
            "code": "207ZC0008X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Informatics",
            "state": "NY",
            "license": "314673-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.