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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

ILHAM DERHAN PUTRA MD
NPI 1770110389
Pathology - Anatomic Pathology & Clinical Pathology in Flushing, NY

Active since March 24, 2020PECOS Enrolled
5645 MAIN ST, FLUSHING, NY 11355(718) 670-1374 Get Directions Write a Review

NPPES record last updated: October 14, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 14, 2026, Oct 7, 2026, Mar 24, 2020 (3 updates tracked since 2020).

About Ilham Derhan Putra Md NPPES

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

ILHAM DERHAN PUTRA MD (NPI 1770110389) is an individual anatomic pathology & clinical pathology provider in Flushing, New York, licensed in New York (337333) and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS, maintains a secondary practice location in New York, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1770110389
Entity TypeIndividualMale
Primary Taxonomy207ZP0102X
Provider Legal NameILHAM DERHAN PUTRACredential: MD
Location Address5645 MAIN STFlushing, NY 11355-5045
Mailing Address525 E 68th StNew York, NY 10065-4870
Phone(718) 670-1374
Sole ProprietorYes
Medical School CMSOtherGraduated 2013
Enumeration DateMarch 24, 2020
Last NPPES UpdateOctober 14, 20263 updates tracked since enumeration
NPPES CertifiedOctober 14, 2026
✔ NPI 1770110389 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPathology · Anatomic Pathology & Clinical PathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ZP0102X
License✔ Licensed in NY · 337333
Definition
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
5645 MAIN ST, Flushing, NY 11355
Open in Google Maps ↗

Secondary Practice Location 1

Location 1525 E 68th StNew York, NY 10065-4870 · Phone (813) 789-3508

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ilham Derhan Putra Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3476026915
PECOS Enrollment IDI20260625002364
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 Ilham Putra reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Weill Medical College Of Cornell
6.8 mi
Hematology & Oncology
520 EAST 70TH ST., STARR 341
New York, NY 10021
  • Reassigned Medicare billing, New York enrollment
  • 980 clinicians in this Medicare group
NPI 1144539958 (646) 962-2010

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 11355 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 20

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

ANA M GHELECHKHANI PA
Physician Assistant (Medical)
5645 MAIN ST
FLUSHING, NY 11355
Queens County (718) 670-2608
PEDRO XAVIER PALACIOS PA-C
Physician Assistant (Medical)
5645 MAIN ST
FLUSHING, NY 11355
Queens County (718) 670-1000
DR. OSCAR ROLDAN
Anesthesiology
5645 MAIN ST
FLUSHING, NY 11355
Queens County (646) 962-9930
ALEXIS TORRES RODRIGUEZ
Internal Medicine (Infectious Disease)
5645 MAIN ST
FLUSHING, NY 11355
Queens County (718) 670-1507
DR. BRENT HOCHSTEIN DO
Student in an Organized Health Care Education/Training Program
5645 MAIN ST
FLUSHING, NY 11355
Queens County (718) 670-2000
DR. PRINCIE NANDINI ROY MD
Student in an Organized Health Care Education/Training Program
5645 MAIN ST
FLUSHING, NY 11355
Queens County (718) 670-2000
ERIC CHROSTOWSKI
Student in an Organized Health Care Education/Training Program
5645 MAIN ST
FLUSHING, NY 11355
Queens County (718) 670-2000
PETER JAESUNG JO
Nurse Practitioner (Family)
5645 MAIN ST
FLUSHING, NY 11355
Queens County (917) 340-4637

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 Ilham Putra's NPI number?

The NPI number for Ilham Putra is 1770110389. It was assigned to this individual provider in the NPPES registry on March 24, 2020.

Where is Ilham Putra located?

Ilham Putra practices at 5645 Main St, Flushing, NY 11355. The listed phone number is (718) 670-1374.

What is Ilham Putra's specialty?

The primary specialty registered for this NPI is Pathology, specializing in Anatomic Pathology & Clinical Pathology, with taxonomy code 207ZP0102X.

Is Ilham Putra enrolled in Medicare?

Yes. Ilham Putra is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Ilham Putra's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ilham Putra reassigns Medicare benefits to Weill Medical College Of Cornell (New York, 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 Ilham Putra'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 Ilham Putra was last updated on October 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 days 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.