Individual provider Active NPI

Keba Raymond

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1467087643
Registry record updated Mar 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F308840-1 Issued in NY
Practice address
1176 5TH Ave
New York, NY 10029-6503
Phone
(212) 241-8709
NPI assigned
Mar 7, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F308840-1 NY Primary

Addresses

Primary practice location

1176 5TH Ave
New York, NY 10029-6503

Mailing address

5124 Avenue K
Brooklyn, NY 11234-3218
Phone (347) 633-1506

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220428001567 NY Practitioner - Nurse Practitioner 1557758109 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
308840NYMDInternal Medicine Physician
F308840-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Jan 21, 2022 Accepting new patients
North Shore-Lij Medical PC CurrentSince Jan 21, 2022 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Plandome, NY 11030

10538 Rockaway Beach Blvd
Rockaway Park, NY 11694
Phone (718) 318-3434

972 Brush Hollow Rd
Westbury, NY 11590

Networks

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

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1583539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583539200000",
    "number": "1467087643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5124 AVENUE K",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112343218",
            "telephone_number": "347-633-1506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 5TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296503",
            "telephone_number": "212-241-8709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAYMOND",
        "first_name": "KEBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-07",
        "last_updated": "2020-03-07",
        "certification_date": "2020-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F308840-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.