NPIMap

Individual provider Active NPI

Gustave Stephen Drivas, M.D.,

  • Internal Medicine Physician
  • Staten Island, NY
National Provider Identifier
1003867730
Registry record updated Feb 19, 2008
On this page

OIG exclusion record

The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:

  • Section 1128a(1) exclusion effective May 20, 2014.

Matched on NPI only. Confirm current status with the OIG exclusions search before relying on it.

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
186334 Issued in NY
Practice address
5405 Hylan Blvd
Staten Island, NY 10312-5241
Phone
(718) 948-3890
Fax
(718) 948-3961
NPI assigned
May 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 186334 NY Primary

Addresses

Primary practice location

5405 Hylan Blvd
Staten Island, NY 10312-5241

Mailing address

5405 Hylan Blvd
Staten Island, NY 10312-5241
Phone (718) 948-3890

Other identifiers 1

IdentifierTypeStateIssuer
01522467MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
LSR Advanced Medical Care PLLC Past Accepting new patients
Gustave S. Drivas MD. PC. Internal Medicine PastSince Apr 25, 2007 Accepting new patients
Palisades Anesthesia Associates LLC Past Accepting new patients
Provider Medical Care PC Past Accepting new patients
SVS Wellcare Medical PLLC PastSince Apr 24, 2006 Accepting new patients
SZS Medical Care PLLC Internal Medicine Past Accepting new patients
Bay Medical Care P.C. PastSince Mar 14, 2005 Accepting new patients
Hogarth Emergency Physicians Past Accepting new patients
Collins Wellcare Medical, P.C. Past Accepting new patients

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203379200000",
    "number": "1003867730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5405 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103125241",
            "telephone_number": "718-948-3890",
            "fax_number": "718-948-3961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103125241",
            "telephone_number": "718-948-3890",
            "fax_number": "718-948-3961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRIVAS",
        "first_name": "GUSTAVE",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.,",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2008-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "186334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01522467",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.