Individual provider Active NPI

Johaira Lidasan Dianalan, MD

  • Internal Medicine Physician
  • Flushing, NY
National Provider Identifier
1568775104
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
271857 Issued in NY
Practice address
14015 Sanford Ave
Flushing, NY 11355-2686
Phone
(718) 826-4000
Fax
(718) 826-4075
NPI assigned
Jul 25, 2010
Last updated
Sep 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 271857 NY Primary

Addresses

Primary practice location

14015 Sanford Ave
Flushing, NY 11355-2686

Mailing address

55 Water St FL 2
New York, NY 10041-0010
Phone (646) 680-2888

Other practice location 1

31-75 23rd Street
Astoria, NY 11106-4134
Phone (718) 956-2200

Other practice location 2

1650 Grand Concourse
Bronx, NY 10457-7606
Phone (718) 960-1234

Other practice location 3

1650 Grand Concourse
Bronx, NY 10457-7606
Phone (718) 960-1234

Other practice location 4

96-10 Metropolitan Ave
Forest Hills, NY 11375-6625
Phone (718) 459-0400

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
I20140227000828 NY Practitioner - Internal Medicine 6608006218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advantagecare Physicians PCGroup PAC ID 2365735008, 307 clinicians

Practice addresses (Care Compare)

14015 Sanford Ave
Flushing, NY 11355-2686
Phone (718) 670-6400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
271857NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantagecare Physicians PC Internal Medicine CurrentSince Jan 1, 2018 Accepting new patients
Advantagecare Physicians PC CurrentSince Jan 1, 2018 Accepting new patients

Locations

233 Nostrand Ave
Brooklyn, NY 11205
Phone (646) 680-1595

14015 Sanford Ave
Flushing, NY 11355
Phone (718) 670-6400

9610 Metropolitan Ave
Forest Hills, NY 11375
Phone (718) 459-0400

3175 23rd St
Long Island City, NY 11106
Phone (718) 956-2200

55 Water St
Fl 2
New York, NY 10041

Networks

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

Interoperability endpoints

  • FHIR API: https://epwebapps.acpny.com/FHIRproxy/ACPNY/api/FHIR/R4
  • Direct secure messaging: jdianalan27233@direct.acpny.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1280016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1568775104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WATER ST FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100410010",
            "telephone_number": "646-680-2888",
            "fax_number": "516-542-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14015 SANFORD AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113552686",
            "telephone_number": "718-826-4000",
            "fax_number": "718-826-4075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31-75 23rd Street",
            "address_purpose": "LOCATION",
            "city": "Astoria",
            "state": "NY",
            "postal_code": "111064134",
            "country_code": "US",
            "telephone_number": "718-956-2200",
            "fax_number": "718-956-2316",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1650 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104577606",
            "country_code": "US",
            "telephone_number": "718-960-1234",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1650 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104577606",
            "country_code": "US",
            "telephone_number": "718-960-1234",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "96-10 Metropolitan Ave",
            "address_purpose": "LOCATION",
            "city": "Forest Hills",
            "state": "NY",
            "postal_code": "113756625",
            "country_code": "US",
            "telephone_number": "718-459-0400",
            "fax_number": "718-670-6479",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIANALAN",
        "first_name": "JOHAIRA",
        "middle_name": "LIDASAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-25",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "271857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.