NPIMap

Individual provider Active NPI

Fasika M Tedla, MD

  • Nephrology Physician
  • New York, NY
National Provider Identifier
1760482822
Registry record updated Nov 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
222336 Issued in NY
Practice address
5 E 98TH St FL 12
New York, NY 10029-6501
Phone
(212) 659-8086
Fax
(212) 731-7220
NPI assigned
Jul 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 222336 NY Primary

Addresses

Primary practice location

5 E 98TH St FL 12
New York, NY 10029-6501

Mailing address

1 Gustave L Levy PL # 1104
New York, NY 10029-6504
Phone (212) 659-8086

Other identifiers 1

IdentifierTypeStateIssuer
02668537MedicaidNY

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
I20050920001150 NY Practitioner - Nephrology 4587698469 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5 E 98TH St
FL 12
New York, NY 10029-6501
Phone (212) 241-8035

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians of Brooklyn, Inc. Current Accepting new patients
University Physicians of Brooklyn, Inc. CurrentSince Sep 1, 2006 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 9, 2019 Accepting new patients
University Physicians of Brooklyn, Inc. Nephrology CurrentSince Sep 1, 2006 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 9, 2019 Accepting new patients
University Physicians of Brooklyn, Inc Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Mount Sinai Hospital Past Accepting new patients
University Physicians of Brooklyn, Inc. Past Accepting new patients

Locations

450 Clarkson Ave
#52
Brooklyn, NY 11203
Phone (718) 270-1584

450 Clarkson Ave
Brooklyn, NY 11203
Phone (718) 270-1603

3839 Flatlands Ave
Ste 100
Brooklyn, NY 11234
Phone (718) 338-5024

5 E 98th St
#12
New York, NY 10029
Phone (212) 241-8303

5 E 98th St
Fl 12
New York, NY 10029
Phone (212) 241-8303

150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

Networks

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

Interoperability endpoints

  • Direct secure messaging: faskiatedla@sunydmc.allscriptsdirect.net

Organizations & group practices 9

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 6

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": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1760482822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL # 1104",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296504",
            "telephone_number": "212-659-8086",
            "fax_number": "212-731-7220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 E 98TH ST FL 12",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296501",
            "telephone_number": "212-659-8086",
            "fax_number": "212-731-7220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDLA",
        "first_name": "FASIKA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "222336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02668537",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.