Active NPI
Ian Pravda, MD
- Dermatology Physician
- Manhasset, NY
National Provider Identifier
1629142047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 111507
- Practice address
- 444 Community Drive
Manhasset, NY 11030 - Phone
- (516) 627-5540
- Fax
- (516) 627-1572
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 111507 | NY | Primary |
Addresses
Primary practice location
444 Community Drive
Manhasset, NY 11030
Mailing address
444 Community Drive
Manhasset, NY 11030
Phone (516) 627-5540
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110517000831 | NY | Practitioner - Dermatology | 9537345004 | Practice locations: Manhasset, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Other, 1970
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
444 Community Dr
Manhasset, NY 11030-3820
Phone (516) 627-5540
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 228 |
| Skin biopsy | 208 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111507 | NY | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629142047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "444 COMMUNITY DRIVE",
"city": "MANHASSET",
"state": "NY",
"postal_code": "11030",
"telephone_number": "516-627-5540",
"fax_number": "516-627-1572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 COMMUNITY DRIVE",
"city": "MANHASSET",
"state": "NY",
"postal_code": "11030",
"telephone_number": "516-627-5540",
"fax_number": "516-627-1572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRAVDA",
"first_name": "IAN",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NY",
"license": "111507",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manhasset, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.