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DR. KENNETH E EZIMOHA MD
NPI 1760377071
Internal Medicine in Whitestone, NY

Active since June 09, 2025PECOS EnrolledAccepts Medicare Assignment
15715 19TH AVE, WHITESTONE, NY 11357(718) 746-0408 Get Directions Write a Review

NPPES record last updated: June 23, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 23, 2025, Jun 9, 2025 (2 updates tracked since 2025).

About Dr. Kenneth E Ezimoha Md NPPES

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

DR. KENNETH E EZIMOHA MD (NPI 1760377071) is an individual internal medicine provider in Whitestone, New York, licensed in New York (P135556) and active in the NPI registry since June 2025. He is enrolled in Medicare PECOS and is a graduate of Other (2004).

NPPES Registry Identity

NPI1760377071
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. KENNETH E EZIMOHACredential: MD
Location Address15715 19TH AVEWhitestone, NY 11357-3820
Mailing Address15715 19th AveWhitestone, NY 11357-3820
Phone(718) 746-0408
Sole ProprietorYes
Medical School CMSOtherGraduated 2004
Enumeration DateJune 9, 2025
Last NPPES UpdateJune 23, 20252 updates tracked since enumeration
NPPES CertifiedJune 23, 2025
✔ NPI 1760377071 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in NY · P135556
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
15715 19TH AVE, Whitestone, NY 11357
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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

Dr. Kenneth E Ezimoha 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 ID4082125950
PECOS Enrollment IDI20250617003125
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 Kenneth Ezimoha reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mill Basin Medical Health PC
13 mi
Internal Medicine
1583 E 66TH ST FL 1
Brooklyn, NY 11234
  • Reassigned Medicare billing, New York enrollment
  • 158 clinicians in this Medicare group
NPI 1346006202 (917) 318-4724

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 11357 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
$153.13 typical visit price
range $67.00 – $201.98
Typical copayment $38.28 (range $16.75 – $50.49)
Most-billed visit code 99204
Established Patient
$116.96 typical visit price
range $21.62 – $163.52
Typical copayment $29.24 (range $5.40 – $40.88)
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 10

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

AMY ISHKANIAN
Speech-Language Pathologist
15715 19TH AVE
WHITESTONE, NY 11357
Queens County (201) 739-0566
NADIRA TAMANNA TAMIM
Internal Medicine
15715 19TH AVE
WHITESTONE, NY 11357
Queens County (718) 746-0400
CAMY ALEXANDRE VALLON
Physical Therapy Assistant
15715 19TH AVE
WHITESTONE, NY 11357
Queens County (347) 522-7137
CLEARVIEW OPERATING CO. LLC
Clinic/Center (Physical Therapy)
15715 19TH AVE
WHITESTONE, NY 11357
Queens County (718) 746-0400
CRISTINA SANCHEZ PTA
Physical Therapy Assistant
15715 19TH AVE
WHITESTONE, NY 11357
Queens County (718) 746-0400
QUEENS CENTER FOR REHABILITATION RESIDENTIAL HEALTHCARE
Home Health
15715 19TH AVE
WHITESTONE, NY 11357
Queens County (718) 746-0400
MERCEDES SANTIAGO PTA
Physical Therapy Assistant
15715 19TH AVE
WHITESTONE, NY 11357
Queens County (718) 746-0400
MR. ELIE CADET
Physical Therapy Assistant
15715 19TH AVE
FLUSHING, NY 11357
Queens County (718) 746-0400

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 Kenneth Ezimoha's NPI number?

The NPI number for Kenneth Ezimoha is 1760377071. It was assigned to this individual provider in the NPPES registry on June 9, 2025.

Where is Kenneth Ezimoha located?

Kenneth Ezimoha practices at 15715 19th Ave, Whitestone, NY 11357. The listed phone number is (718) 746-0408.

What is Kenneth Ezimoha's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Kenneth Ezimoha enrolled in Medicare?

Yes. Kenneth Ezimoha 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 organization bills Medicare for Kenneth Ezimoha's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Ezimoha reassigns Medicare benefits to Mill Basin Medical Health PC (Brooklyn, NY). 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 Kenneth Ezimoha'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 Kenneth Ezimoha was last updated on June 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.