Mubushar Ikram Raza

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

307814 Issued in NY

Practice address

55 2ND Ave Unit 2
Brentwood, NY 11717-4665

Phone

(631) 983-3237

Fax

(631) 961-8775

NPI assigned

Jul 19, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Nurse Practitioner

Education

State University of New York at Stony Brook, School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

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

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CEBJDD/Endpoint/CEBJDD

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.

• Station Care NP in Adult Health PC

  • Adult Health Nurse Practitioner
  • Brentwood, NY
  • NPI 1801605761
  Medicare reassignment NPD Authorized official
• Station Medical PC

  • Primary Care Nurse Practitioner
  • Huntington Station, NY
  • NPI 1821828047
  NPD Authorized official

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

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769126400000",
    "number": "1588017164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 2ND AVE UNIT 2",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117174665",
            "telephone_number": "631-983-3273",
            "fax_number": "631-961-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 2ND AVE UNIT 2",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117174665",
            "telephone_number": "631-983-3237",
            "fax_number": "631-961-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAZA",
        "first_name": "MUBUSHAR",
        "middle_name": "IKRAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-19",
        "last_updated": "2026-01-23",
        "certification_date": "2026-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "307814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "307814",
            "identifier": "307814",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raquel L Lopez DDS Family Dentistry P.C
• Muzammil Imtiaz Rasul, RN
• Tabraiz Rasul, MD
• Samantha Rauch, CASAC-T
• Rukhshanda Rauf, MSW
• Sully Reinoso Jaramillo, M.S PSYCHOLOGIST
• Lisa Dawn Reisner, R.D.
• Schneidine Rely-Supreme
• Myldraide Remy-Jocelyn, BSN
• Vivian L. Renta-Skyer, OD

• Adult Health Nurse Practitioner in Brentwood, NY
• Providers in Brentwood, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.