Marina Yusupov, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

016801 Issued in NY

Practice address

11239 68TH Ave
Forest Hills, NY 11375-2937

Phone

(917) 442-2439

NPI assigned

Oct 31, 2013

Last updated

Oct 31, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology PCGroup PAC ID 3274526850, 67 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: marinayusupov@nslijmedgr.allscriptsdirect.net
• Direct secure messaging: marinayusupov@northwell.allscriptsdirect.net
• Direct secure messaging: myusupov@advderm.emadirect.md

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.

• Advanced Dermatology PC

  • Dermatology Physician
  • New Hyde Park, NY
  • NPI 1134201460
  Medicare reassignment Care Compare group
• North Shore-Lij Medical PC

  dba NHPP Cardiology at Great Neck

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment NPD
• New York City Health and Hospitals Corporation

  dba Gouverneur Healthcare Services

  • Clinic/Center
  • New York, NY
  • NPI 1548208127
  Medicare reassignment
• New York City Health and Hospitals Corporation

  dba Elmhurst Hospital Center

  • General Acute Care Hospital
  • Elmhurst, NY
  • NPI 1063426377
  NPD
• New York City Health and Hospitals Corporation

  dba Henry J. Carter Specialty Hospital

  • Clinic/Center
  • New York, NY
  • NPI 1538943469
  NPD
• Northwell Health

  • Rehabilitation Hospital Unit
  • Glen Cove, NY
  • NPI 1619336260
  NPD
• Anthony Buglino DO PLLC

  • Plastic Surgery Physician
  • Woodbury, NY
  • NPI 1730582834
  NPD (past)
• Dermatologic Surgery of Lexington Ave PC

  • Specialist
  • New York, NY
  • NPI 1831417468
  NPD (past)
• Howard D. Solomon, DO, PC

  • Procedural Dermatology Physician
  • Forest Hills, NY
  • NPI 1598054520
  NPD (past)

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

{
    "created_epoch": "1383177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383177600000",
    "number": "1851729735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11239 68TH AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752937",
            "telephone_number": "917-442-2439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11239 68TH AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752937",
            "telephone_number": "917-442-2439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YUSUPOV",
        "first_name": "MARINA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-31",
        "last_updated": "2013-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yanna Yukhananova
• Erica Sharona Yunatanov
• Rachel Yunatanov, OTR/L
• Rachel Pilar Yurovsky
• Artem Yusupov, AUD
• Michelle Yusupov
• Pinkhoz Yusupov, OPTICIAN
• Sara Yusupov
• Stephany Yusupov, OTR/L
• Yaffa Yusupov, PHARM.D.

• Physician Assistant in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; 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.