NPIMap

Individual provider Active NPI

Andy Fan, M.D.

  • Gastroenterology Physician
  • Great Neck, NY
National Provider Identifier
1730107327
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
239285 Issued in NY
Practice address
488 Great Neck Rd Ste 300
Great Neck, NY 11021-4308
Phone
(516) 482-6747
Fax
(516) 482-4851
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 239285 NY Primary

Addresses

Primary practice location

488 Great Neck Rd Ste 300
Great Neck, NY 11021-4308

Mailing address

488 Great Neck Rd Ste 300
Great Neck, NY 11021-4308
Phone (516) 482-6747

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address afan54620@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060509000817 NY Practitioner - Gastroenterology 4880605583 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
State University of New York Downstate Medical Center, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

259 1St St
Mineola, NY 11501-3957
Phone (516) 222-8600

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy74
Upper gastrointestinal (GI) endoscopy for acid reflux45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
239285NYMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NYU Langone Hospitals CurrentSince Apr 6, 2017 Accepting new patients
New York University Gastroenterology CurrentSince Jun 15, 2012 Accepting new patients
NYU Langone Hospitals CurrentSince Apr 6, 2017 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
N. S. So Island Diag GRP Past Accepting new patients

Locations

1630 E 14th St
Brooklyn, NY 11229
Phone (516) 612-3722

488 Great Neck Rd
Ste 300
Great Neck, NY 11021
Phone (516) 482-6747

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

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

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1730107327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "488 GREAT NECK RD STE 300",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214308",
            "telephone_number": "516-482-6747",
            "fax_number": "516-482-4851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "488 GREAT NECK RD STE 300",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214308",
            "telephone_number": "516-482-6747",
            "fax_number": "516-482-4851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "ANDY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "239285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "afan54620@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "488 Great Neck Rd Ste 300",
            "city": "Great Neck",
            "state": "NY",
            "country_code": "US",
            "postal_code": "110214308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.