Individual provider Active NPI

Angela Simkhaeva, PT

  • Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1972532273
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
016693-1 Issued in NY
Practice address
3045 Brighton 12TH St
Suite 1G
Brooklyn, NY 11235-5762
Phone
(718) 332-3132
Fax
(718) 332-3355
NPI assigned
Jul 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 016693-1 NY Primary

Addresses

Primary practice location

3045 Brighton 12TH St
Suite 1G
Brooklyn, NY 11235-5762

Mailing address

3045 Brighton 12TH St
Suite 1G
Brooklyn, NY 11235-5762
Phone (718) 332-3132

Other identifiers 2

IdentifierTypeStateIssuer
Q3975OtherNYEMPIRE BLUECROSS BLUE SHI
01897709MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120425000180 NY Practitioner - Physical Therapist in Private Practice 4082876867 Practice locations: Brooklyn, NY

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3045 Brighton 12TH St
Apt 1G
Brooklyn, NY 11235-5741
Phone (718) 332-3132

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016693-1NYMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972532273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3045 BRIGHTON 12TH ST",
            "address_2": "SUITE 1G",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355762",
            "telephone_number": "718-332-3132",
            "fax_number": "718-332-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3045 BRIGHTON 12TH ST",
            "address_2": "SUITE 1G",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355762",
            "telephone_number": "718-332-3132",
            "fax_number": "718-332-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMKHAEVA",
        "first_name": "ANGELA",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "016693-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUECROSS BLUE SHI",
            "identifier": "Q3975",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01897709",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.