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ETHAN DAVOUDZADEH MD
NPI 1538628649
Radiology - Vascular & Interventional Radiology in New York, NY

Active since March 18, 2019PECOS EnrolledAccepts Medicare Assignment
1275 YORK AVE, NEW YORK, NY 10065(212) 639-2000 Get Directions Write a Review

NPPES record last updated: May 2, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Ethan Davoudzadeh Md NPPES

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

ETHAN DAVOUDZADEH MD (NPI 1538628649) is an individual vascular & interventional radiology provider in New York, New York, licensed in New York (311958) and active in the NPI registry since March 2019. He is enrolled in Medicare PECOS and is a graduate of State University Of New York Downstate Medical Center (2019).

NPPES Registry Identity

NPI1538628649
Entity TypeIndividualMale
Primary Taxonomy2085R0204X
Provider Legal NameETHAN DAVOUDZADEHCredential: MD
Location Address1275 YORK AVENew York, NY 10065-6007
Mailing Address1275 York AveNew York, NY 10065-6007 · (212) 639-2000
Phone(212) 639-2000
Sole ProprietorNo
Medical School CMSState University Of New York Downstate Medical CenterGraduated 2019
Enumeration DateMarch 18, 2019
Last NPPES UpdateMay 2, 2025
NPPES CertifiedMay 2, 2025
✔ NPI 1538628649 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyRadiology · Vascular & Interventional RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0204X
License✔ Licensed in NY · 311958
Definition
A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1275 YORK AVE, New York, NY 10065
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ethan Davoudzadeh Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7315453495
PECOS Enrollment IDI20250724001080
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 Reassignments

4

Medicare enrollment records show Ethan Davoudzadeh reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mskcc Radiology Group
Same address
Diagnostic Radiology
1275 YORK AVE
New York, NY 10021
  • Reassigned Medicare billing, New York enrollment
  • 302 clinicians in this Medicare group
NPI 1639159692 (646) 227-3813
Msk Bergen
21 mi
Medical Oncology
225 SUMMIT AVE
Montvale, NJ 07645
  • Reassigned Medicare billing, New Jersey enrollment
  • 401 clinicians in this Medicare group
NPI 1558814657 (908) 542-3336
Msk Monmouth
29 mi
Medical Oncology
480 RED HILL RD
Middletown, NJ 07748
  • Reassigned Medicare billing, New Jersey enrollment
  • 464 clinicians in this Medicare group
NPI 1922459163 (908) 542-3007
Memorial Sloan Kettering Cancer Center At Basking Ridge New Jersey
34 mi
Medical Oncology
136 MOUNTAIN VIEW BLVD
Basking Ridge, NJ 07920
  • Reassigned Medicare billing, New Jersey enrollment
  • 385 clinicians in this Medicare group
NPI 1184637886 (908) 542-3000

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 10065 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
$102.04 typical visit price
range $65.69 – $198.19
Typical copayment $25.51 (range $16.42 – $49.54)
Most-billed visit code 99203
Established Patient
$81.44 typical visit price
range $21.20 – $160.66
Typical copayment $20.36 (range $5.30 – $40.16)
Most-billed visit code 99213
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.

MRS. ZANA CORREA NP
Nurse Practitioner (Adult Health)
1275 YORK AVE
NEW YORK, NY 10065
New York County (646) 422-4450
MS. NICOLE NOELLE REYNOLDS NP
Nurse Practitioner (Acute Care)
1275 YORK AVE
NEW YORK, NY 10065
New York County (212) 682-7326
MRS. SHARLENE SEECHARRAN RN, NP
Nurse Practitioner (Adult Health)
1275 YORK AVE
NEW YORK, NY 10065
New York County (212) 639-2203
CHRISTINA MADINABEITIA DURNEY
Nurse Practitioner (Pediatrics)
1275 YORK AVE
NEW YORK, NY 10065
New York County (212) 639-5164
ALISON GAIL MASSEY ANP
Nurse Practitioner (Adult Health)
1275 YORK AVE
NEW YORK, NY 10065
New York County (212) 639-2000
MICHAEL SCORDO
Internal Medicine (Hematology & Oncology)
1275 YORK AVE
NEW YORK, NY 10065
New York County (212) 639-2000
AMPARO G CAMACHO NP
Nurse Practitioner (Adult Health)
1275 YORK AVE
NEW YORK, NY 10065
New York County (646) 422-4417
DR. INES NIKOLOVSKI MBBS
Special Hospital
1275 YORK AVE, MEMORIAL SLOAN KETTERING CANCER CENTRE
NEW YORK, NY 10065
New York County (212) 639-2000

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 Ethan Davoudzadeh's NPI number?

The NPI number for Ethan Davoudzadeh is 1538628649. It was assigned to this individual provider in the NPPES registry on March 18, 2019.

Where is Ethan Davoudzadeh located?

Ethan Davoudzadeh practices at 1275 York Ave, New York, NY 10065. The listed phone number is (212) 639-2000.

What is Ethan Davoudzadeh's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Vascular & Interventional Radiology, with taxonomy code 2085R0204X.

Is Ethan Davoudzadeh enrolled in Medicare?

Yes. Ethan Davoudzadeh is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Ethan Davoudzadeh's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ethan Davoudzadeh reassigns Medicare benefits to 4 organizations: Mskcc Radiology Group (New York, NY), Msk Bergen (Montvale, NJ), Msk Monmouth (Middletown, NJ) and Memorial Sloan Kettering Cancer Center At Basking Ridge New Jersey (Basking Ridge, NJ). Each 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 Ethan Davoudzadeh'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 Ethan Davoudzadeh was last updated on May 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months 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.