Individual provider Active NPI

Mickael Marc Antoine Amine Khouzami, MD

  • Anesthesiology Physician
  • Buffalo, NY
National Provider Identifier
1780359257
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
320679 Issued in NY
Practice address
1001 Main St # K3502
Buffalo, NY 14203-1009
Phone
(716) 323-6570
NPI assigned
Aug 16, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 320679 NY Primary

Addresses

Primary practice location

1001 Main St # K3502
Buffalo, NY 14203-1009

Mailing address

1000 10TH Ave
New York, NY 10019-1147
Phone (347) 556-4454

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
I20231026002165 NY Practitioner - Anesthesiology 2769838705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Great Lakes Anesthesiology PCGroup PAC ID 7113997529, 90 clinicians

Practice addresses (Care Compare)

818 Ellicott St
Buffalo, NY 14203-1021
Phone (716) 323-6570

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Anesthesiology, PC CurrentSince Aug 22, 2023 Accepting new patients

Locations

818 Ellicott St
Buffalo, NY 14203
Phone (716) 323-2000

2605 Harlem Rd
Cheektowaga, NY 14225
Phone (716) 891-2315

3095 Harlem Rd
Cheektowaga, NY 14225
Phone (716) 896-2245

2950 Elmwood Ave
Tonawanda, NY 14217
Phone (716) 447-6100

Organizations & group practices 1

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 9

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": "1629072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1780359257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191147",
            "telephone_number": "347-556-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST # K3502",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031009",
            "telephone_number": "716-323-6570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOUZAMI",
        "first_name": "MICKAEL MARC ANTOINE",
        "middle_name": "AMINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-16",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "320679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.