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IRINA KHAKHANOV
NPI 1417617002
Nurse Practitioner - Family in Phoenix, AZ

Active since December 22, 2021PECOS Enrolled
5777 E MAYO BLVD, PHOENIX, AZ 85054(646) 249-5910 Get Directions Write a Review

NPPES record last updated: December 22, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Irina Khakhanov NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IRINA KHAKHANOV (NPI 1417617002) is an individual family provider in Phoenix, Arizona, licensed in Arizona (F11210467) and active in the NPI registry since December 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1417617002
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameIRINA KHAKHANOV
Location Address5777 E MAYO BLVDPhoenix, AZ 85054-4502
Mailing Address15437 N 13th AvePhoenix, AZ 85023-4484 · (646) 249-5910
Phone(646) 249-5910
Sole ProprietorYes
Enumeration DateDecember 22, 2021
NPPES CertifiedDecember 22, 2021
✔ NPI 1417617002 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in AZ · F11210467
5777 E MAYO BLVD, Phoenix, AZ 85054
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Irina Khakhanov is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Irina Khakhanov reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Bliss Medical Spa And Wellness PLLC
13 mi
Family Medicine
5710 W BELL RD STE 29
Glendale, AZ 85308
  • Reassigned Medicare billing, Arizona enrollment
  • 2 clinicians in this Medicare group
NPI 1427873835 (602) 880-8777

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85054 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MEAGAN ELIZABETH TIBBO M.D.
Orthopaedic Surgery
5777 E MAYO BLVD
PHOENIX, AZ 85054
Maricopa County (480) 515-6296
MISS AMY LETICIA BROWN PA-C
Physician Assistant
5777 E MAYO BLVD
PHOENIX, AZ 85054
Maricopa County (480) 301-8000
KRISTINA YANCEY
Radiology (Diagnostic Radiology)
5777 E MAYO BLVD
PHOENIX, AZ 85054
Maricopa County (480) 342-2000
KATHERINE ANNE LESPRON LMSW
Social Worker
5777 E MAYO BLVD
PHOENIX, AZ 85054
Maricopa County (480) 342-4005
KASSANDRA HYDE APRN
Clinical Nurse Specialist
5777 E MAYO BLVD
PHOENIX, AZ 85054
Maricopa County (480) 342-3962
DIANA M BUI M.D.
Emergency Medicine
5777 E MAYO BLVD
PHOENIX, AZ 85054
Maricopa County (480) 301-8000
JENNIFER S PALERMO P.A.
Physician Assistant
5777 E MAYO BLVD
PHOENIX, AZ 85054
Maricopa County (480) 301-8000
ALICIA CHEN M.D.
Radiology (Diagnostic Radiology)
5777 E MAYO BLVD
PHOENIX, AZ 85054
Maricopa County (480) 301-8000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Irina Khakhanov's NPI number?

The NPI number for Irina Khakhanov is 1417617002. It was assigned to this individual provider in the NPPES registry on December 22, 2021.

Where is Irina Khakhanov located?

Irina Khakhanov practices at 5777 E Mayo Blvd, Phoenix, AZ 85054. The listed phone number is (646) 249-5910.

What is Irina Khakhanov's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Irina Khakhanov enrolled in Medicare?

Yes. Irina Khakhanov is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Irina Khakhanov's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Irina Khakhanov reassigns Medicare benefits to Bliss Medical Spa And Wellness PLLC (Glendale, AZ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Irina Khakhanov's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Irina Khakhanov was last updated on December 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.