NPIMap

Organization Active NPI

Beacon Health Medical PC

  • Internal Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1679393052
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
BEACON HEALTH MEDICAL PC
Practice address
17 W 9TH St
Brooklyn, NY 11231-2501
Phone
(718) 599-9090
Fax
(347) 618-5973
NPI assigned
Oct 11, 2024
Last updated
Oct 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Authorized official

Name
Mark Ilyagu, MDNPI 1073994711
Title
Owner
Phone
(717) 716-7107

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

17 W 9TH St
Brooklyn, NY 11231-2501

Mailing address

17 W 9TH St
Brooklyn, NY 11231-2501
Phone (718) 599-9090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241029000261 NY Part B Supplier - Clinic/Group Practice 1658804760 Receives reassigned benefits from 60 practitioners
Practice locations: New York, NY; Flushing, NY; Bronx, NY; Brooklyn, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1728604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1679393052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 W 9TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112312501",
            "telephone_number": "718-599-9090",
            "fax_number": "347-618-5973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 W 9TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112312501",
            "telephone_number": "718-599-9090",
            "fax_number": "347-618-5973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON HEALTH MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-11",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "ILYAGU",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "717-716-7107",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.