Individual provider Active NPI

Murisiku Raifu, M.D.

  • Neurological Surgery Physician
  • Flushing, NY
National Provider Identifier
1467616003
Registry record updated Sep 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
A87366 Issued in CA
Practice address
5645 Main St
RM-M204
Flushing, NY 11355-5045
Phone
(718) 445-0220
Fax
(718) 939-1167
NPI assigned
Jul 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X A87366 CA Primary

Addresses

Primary practice location

5645 Main St
RM-M204
Flushing, NY 11355-5045

Mailing address

5645 Main St
Flushing, NY 11355-5045
Phone (718) 670-1837

Other identifiers 1

IdentifierTypeStateIssuer
03039498MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20150401002171 CA Practitioner - Neurosurgery 1052486693 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
87366CAMDMental Health Counselor
A87366CAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
In-Line Medical, Inc., a Professional Medical Corporation Neurological Surgery CurrentSince Nov 15, 2018 Accepting new patients
In-Line Medical, Inc., a Professional Medical Corporation CurrentSince Nov 15, 2018 Accepting new patients

Locations

9663 Santa Monica Blvd
Beverly Hills, CA 90210
Phone (310) 275-8377

16311 Ventura Blvd
Ste 655
Encino, CA 91436
Phone (424) 217-1301

Interoperability endpoints

  • Direct secure messaging: mraifu@1739.securemail.prognocis.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285718400000",
    "number": "1467616003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045",
            "telephone_number": "718-670-1837",
            "fax_number": "718-661-7186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "address_2": "RM-M204",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045",
            "telephone_number": "718-445-0220",
            "fax_number": "718-939-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAIFU",
        "first_name": "MURISIKU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-14",
        "last_updated": "2010-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "A87366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03039498",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.