Individual provider Active NPI

Emily Avanessov, FNP

  • Family Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1831913755
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
355353 Issued in NY
Practice address
260 Avenue X
Brooklyn, NY 11223-5940
Phone
(718) 336-8855
NPI assigned
Nov 8, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 355353 NY Primary

Addresses

Primary practice location

260 Avenue X
Brooklyn, NY 11223-5940

Mailing address

260 Avenue X
Brooklyn, NY 11223-5940
Phone (718) 336-8855

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
I20241203001161 NY Practitioner - Nurse Practitioner 5294260030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Century Medical and Dental Center IncGroup PAC ID 8729070669, 107 clinicians

Practice addresses (Care Compare)

260 Ave X
Brooklyn, NY 11223-5940
Phone (718) 336-8855

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
355353NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Century Medical & Dental Center Inc CurrentSince Oct 25, 2024 Accepting new patients
Suny Downstate Medical Center PastSince Oct 25, 2024 Accepting new patients

Locations

770 Flatbush Ave
Brooklyn, NY 11226
Phone (347) 627-3988

260 Avenue X
Brooklyn, NY 11223
Phone (718) 336-8855

200 Livingston St
Brooklyn, NY 11201
Phone (718) 522-3399

827 11th Ave
New York, NY 10019
Phone (212) 257-9778

Networks

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

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1731024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1831913755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 AVENUE X",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112235940",
            "telephone_number": "718-336-8855",
            "fax_number": "718-336-6479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 AVENUE X",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112235940",
            "telephone_number": "718-336-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVANESSOV",
        "first_name": "EMILY",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-08",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "355353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.