Individual provider Active NPI

Khalida Ismailova, M.D.

  • Hospitalist Physician
  • New York, NY
National Provider Identifier
1790137941
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
301570 Issued in NY
Practice address
1111 Amsterdam Ave
New York, NY 10025-1716
Phone
(212) 523-2900
NPI assigned
Jul 11, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 301570 NY Primary

Addresses

Primary practice location

1111 Amsterdam Ave
New York, NY 10025-1716

Mailing address

1111 Amsterdam Ave
New York, NY 10025-1716
Phone (212) 523-2900

Other practice location 1

638 Columbus Ave
New York, NY 10024-1406
Phone (212) 523-8672

Other practice location 2

1000 10th Ave
New York, NY 10019-1147
Phone (212) 523-8663

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
I20191108001044 NY Practitioner - Internal Medicine 8527490721 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1111 Amsterdam Ave
New York, NY 10025-1716
Phone (212) 523-6500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
301570NYMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Oct 9, 2019 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Oct 9, 2019 Accepting new patients
St Lukes Roosevelt Hospital Center Past Accepting new patients
Icahn School of Medicine at Mount Sinai Internal Medicine Past Accepting new patients

Locations

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

1111 Amsterdam Ave
New York, NY 10025
Phone (212) 523-2309

17 E 102nd St
New York, NY 10029
Phone (212) 241-7968

638 Columbus Ave
New York, NY 10024
Phone (212) 523-8672

150 E 42nd St
Fl 9
New York, NY 10017
Phone (646) 605-8119

Networks

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

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.

Hospital & facility affiliations 2

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": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1790137941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 AMSTERDAM AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100251716",
            "telephone_number": "212-523-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 AMSTERDAM AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100251716",
            "telephone_number": "212-523-2900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "638 Columbus Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100241406",
            "country_code": "US",
            "telephone_number": "212-523-8672",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 10th Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100191147",
            "country_code": "US",
            "telephone_number": "212-523-8663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ISMAILOVA",
        "first_name": "KHALIDA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-11",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "301570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.