Individual provider Active NPI

Eleazer Yousefzadeh, M.D.

  • Gastroenterology Physician
  • Garden City, NY
National Provider Identifier
1700029485
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
273391-1 Issued in NY
Practice address
1205 Franklin Ave
Suite 150
Garden City, NY 11530-1629
Phone
(516) 222-0067
Fax
(516) 222-0071
NPI assigned
Apr 10, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 25MA08552400 NJ
Gastroenterology Physician 207RG0100X 273391-1 NY Primary

Addresses

Primary practice location

1205 Franklin Ave
Suite 150
Garden City, NY 11530-1629

Mailing address

1205 Franklin Ave
Suite 150
Garden City, NY 11530-1629
Phone (516) 222-0067

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
I20140809000104 NY Practitioner - Gastroenterology 9830348028 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians

Practice addresses (Care Compare)

90 S Bedford Rd
Mount Kisco, NY 10549-3412
Phone (914) 241-1050

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
72.13
Promoting interoperability
91
Improvement activities
40
Cost
75.81

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy170
Upper gastrointestinal (GI) endoscopy for acid reflux171

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
273391-1NYMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. Gastroenterology CurrentSince Sep 1, 2022 Accepting new patients
Islandwide Gastroenterology PC Gastroenterology CurrentSince Jun 1, 2014 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Mount Kisco Medical Group Gastroenterology Past Accepting new patients

Locations

2322 30th Ave
Astoria, NY 11102
Phone (718) 267-2763

1205 Franklin Ave
Ste 150
Garden City, NY 11530
Phone (516) 222-0067

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

Philadelphia, PA 19195

Interoperability endpoints

  • Direct secure messaging: eyousefzadeh47189@direct.optum.com

Organizations & group practices 4

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": "1239321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422403200000",
    "number": "1700029485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 FRANKLIN AVE",
            "address_2": "SUITE 150",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115301629",
            "telephone_number": "516-222-0067",
            "fax_number": "516-222-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 FRANKLIN AVE",
            "address_2": "SUITE 150",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115301629",
            "telephone_number": "516-222-0067",
            "fax_number": "516-222-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUSEFZADEH",
        "first_name": "ELEAZER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-10",
        "last_updated": "2015-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NJ",
            "license": "25MA08552400",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "273391-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, NY

Sources for this page

Verify at the official NPI Registry.