Maurice A Racine, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

139080 Issued in NY

Practice address

828 State Route 11
Champlain, NY 12919-4966

Phone

(518) 298-2691

Fax

(518) 298-8241

NPI assigned

Sep 11, 2006

Last updated

Apr 4, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Hudson Headwaters Health Network

  • Primary Care Clinic/Center
  • Champlain, NY
  • NPI 1245285170
  NPD

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1013011006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 STATE ROUTE 11",
            "city": "CHAMPLAIN",
            "state": "NY",
            "postal_code": "129194966",
            "telephone_number": "518-298-2691",
            "fax_number": "518-298-8241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACINE",
        "first_name": "MAURICE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "139080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00669049",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "maurice.racine.1@1823.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "828 State Route 11",
            "city": "Champlain",
            "state": "NY",
            "country_code": "US",
            "postal_code": "129194966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amy Murphy, RPH
• Northeastern Clinton Central School
• Christine O'Brian
• Stephanie Papaconstantinou, MD
• M Christine Prell, LCSW-R CASAC
• Rite Aid of New York Inc (Rite Aid Pharmacy 04722)
• Courtney Elizabeth Shutts, RN
• Lisa Marie Skarling, MD
• Dorothea Burget Southwick, P.T.
• Hillary E Southwick, LMHC

• Family Medicine Physician in Champlain, NY
• Providers in Champlain, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.