Provider Demographics
| NPI: | 1811946775 |
|---|---|
| Name: | COMMUNITY CARE PHYSICIANS, PC |
| Entity type: | Organization |
| Organization Name: | COMMUNITY CARE PHYSICIANS, PC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CREDENTIALING MANAGER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DEBBY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | COONS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 518-213-0478 |
| Mailing Address - Street 1: | 711 TROY SCHENECTADY RD STE 203 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LATHAM |
| Mailing Address - State: | NY |
| Mailing Address - Zip Code: | 12110-2461 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 518-782-3700 |
| Mailing Address - Fax: | 518-782-3799 |
| Practice Address - Street 1: | 501 NEW KARNER RD |
| Practice Address - Street 2: | SUITE 1A |
| Practice Address - City: | ALBANY |
| Practice Address - State: | NY |
| Practice Address - Zip Code: | 12205-3882 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 518-452-1337 |
| Practice Address - Fax: | 518-724-6660 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | COMMUNITY CARE PHYSICIANS, PC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-05-09 |
| Last Update Date: | 2019-03-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NY | 207RP1001X, 208M00000X | |
| 207R00000X, 208000000X, 207RE0101X, 2080P0006X, 207RN0300X, 207RP1001X, 133V00000X, 207K00000X, 2084N0400X, 363A00000X, 363L00000X, 207Q00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
| No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
| No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NY | 02177719 | Medicaid | |
| NY | 94866 | Other | MVP GROUP ID NUMBER |
| NY | 3416 | Other | CDPHP GROUP ID NUMBER |
| NY | 02177719 | Medicaid | |
| NY | 94866 | Other | MVP GROUP ID NUMBER |
