Khaled Omar Elbanna, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

224801-1 Issued in NY

Practice address

2543 Steinway Street
Astoria, NY 11103

Phone

(718) 706-8060

Fax

(718) 706-8650

NPI assigned

May 5, 2006

Reactivated

Feb 1, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

General Practice

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

My Medical PCGroup PAC ID 0143610600, 93 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• My Medical PC

  • Family Medicine Physician
  • Valley Cottage, NY
  • NPI 1518637891
  Medicare reassignment Care Compare group NPD
• Lwhmedical PC

  • Family Medicine Physician
  • Bronx, NY
  • NPI 1184968232
  Medicare reassignment NPD
• Medical Services of Northeastern Queens PLLC

  • Internal Medicine Physician
  • Jamaica, NY
  • NPI 1184311441
  Medicare reassignment NPD
• Prompt Care Inc

  • Clinic/Center
  • Astoria, NY
  • NPI 1356521298
  NPD (past) Authorized official
• Advanced Wound Care Medical Practice, PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Hicksville, NY
  • NPI 1295783934
  NPD (past)
• Lifeco Medical, P.C.

  • Emergency Medicine Physician
  • Forest Hills, NY
  • NPI 1922031905
  NPD (past)
• Newyork-Presbyterian/Queens

  • Cardiovascular Disease Physician
  • Flushing, NY
  • NPI 1013960962

  Family Medicine

  NPD (past)
• Peyman Younesi MD PLLC

  • Internal Medicine Physician
  • Fresh Meadows, NY
  • NPI 1891053328
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1790733210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2543 STEINWAY STREET",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111033503",
            "telephone_number": "718-706-8060",
            "fax_number": "718-707-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2543 STEINWAY STREET",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "11103",
            "telephone_number": "718-706-8060",
            "fax_number": "718-706-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELBANNA",
        "first_name": "KHALED",
        "middle_name": "OMAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "deactivation_date": "2020-12-09",
        "reactivation_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "224801-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "4C7293",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Newmark Eisenstein
• Sehar Ejaz, M.D.
• Ramaytiwatie El Sisi
• Zeyad Elamrousy, DPT
• Mahy Elaskandrany, PHARMD
• Shahera Mohammed Eldeken I, A
• Eleanor D Yarisse
• Rena Eleazar, PT, DPT, CSCS
• Eleftherios S. Gavriil, DDS PC
• Elite Medical & Rehab Services PC

• Family Medicine Physician in Astoria, NY
• Providers in Astoria, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.