Individual provider Active NPI

Olga Yakobov

  • Physician Assistant
  • Flushing, NY
National Provider Identifier
1740614445
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
016764-1 Issued in NY
Practice address
5645 Main St
W-LL 300
Flushing, NY 11355-5045
Phone
(718) 445-0220
Fax
(718) 661-7405
NPI assigned
Aug 29, 2013
Last updated
Jan 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 016764-1 NY Primary

Addresses

Primary practice location

5645 Main St
W-LL 300
Flushing, NY 11355-5045

Mailing address

5645 Main St
W-LL 300
Flushing, NY 11355-5045
Phone (718) 445-0220

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address oly9001@direct.nyp.org Direct
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/ Health Information Exchange (HIE)
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140116001775 NY Practitioner - Physician Assistant 2163650227 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11205 A Queens Blvd
Forest Hills, NY 11375-8311
Phone (718) 303-3725

11205 Queens Blvd
Forest Hills, NY 11375-8311

16303 Horace Harding Expy
Fresh Meadows, NY 11365-1449

18603 Union Tpke
Flushing, NY 11366-1733
Phone (718) 670-1837

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
016764-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York Queens Medicine and Surgery, P.C. CurrentSince May 3, 2016 Accepting new patients
Fpa Hospital Based CurrentSince Jul 20, 2014 Accepting new patients
Nes Medical Services of New York PC CurrentSince Oct 15, 2013 Accepting new patients
Fpa Hospital Based CurrentSince Jul 20, 2014 Accepting new patients
Bimc Faculty Practice Physician Assistant Past Accepting new patients

Locations

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7123

5645 Main St
#300
Flushing, NY 11355
Phone (718) 303-3720

16303 Horace Harding Expy
Fl 2
Fresh Meadows, NY 11365
Phone (718) 888-9121

18603 Union Tpke
Fresh Meadows, NY 11366
Phone (718) 670-1837

455 E Bay Dr
Long Beach, NY 11561
Phone (516) 432-8000

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

1176 5th Ave
New York, NY 10029
Phone (212) 241-6237

1981 Marcus Ave
Ste 208
North New Hyde Park, NY 11042
Phone (718) 670-1415

Networks

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

Interoperability endpoints

  • Direct secure messaging: oly9001@direct.nyp.org

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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": "1377734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1740614445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "address_2": "W-LL 300",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045",
            "telephone_number": "718-445-0220",
            "fax_number": "718-661-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 MAIN ST",
            "address_2": "W-LL 300",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555045",
            "telephone_number": "718-445-0220",
            "fax_number": "718-661-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAKOBOV",
        "first_name": "OLGA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-29",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016764-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oly9001@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "direct address",
            "address_1": "18603 Union Tpke",
            "city": "Fresh Meadows",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113661733",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "18603 Union Tpke",
            "city": "Fresh Meadows",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113661733",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "18603 Union Tpke",
            "city": "Fresh Meadows",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113661733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.