David C Collymore, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

225742 Issued in NY

Practice address

1776 Clay Ave
Bronx, NY 10457-7239

Phone

(718) 299-1100

Fax

(718) 299-4633

NPI assigned

Aug 23, 2005

Last updated

Jan 30, 2012By 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

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Promesa Residential Health Care Facility, Inc.

  dba Casa Promesa

  • Skilled Nursing Facility
  • Bronx, NY
  • NPI 1801833652

  Adp of the SNF, Corporate Director, Operational/Managerial Control

  CMS ownership

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.

• Out of the Darkness, Inc

  • Substance Abuse Rehabilitation Facility
  • Rochester, NY
  • NPI 1770396996
  Medicare reassignment NPD
• Queens Village Committee for Mental Health for J-Cap, Inc

  • Multi-Specialty Clinic/Center
  • Jamaica, NY
  • NPI 1679641757
  Medicare reassignment NPD
• United Bronx Parents, Inc.

  • Substance Abuse Rehabilitation Facility
  • Bronx, NY
  • NPI 1013197268
  Medicare reassignment NPD
• Bronx Addiction Services Integrated Concepts System Inc

  • Multi-Specialty Clinic/Center
  • Bronx, NY
  • NPI 1568492718
  Medicare reassignment
• La Casa de Salud Inc.

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
  • NPI 1548260870
  Medicare reassignment
• El Regreso, Inc.

  • Substance Abuse Rehabilitation Facility
  • Brooklyn, NY
  • NPI 1760675359
  NPD (past)
• Greenhope Services for Women, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • New York, NY
  • NPI 1194942003
  NPD (past)
• La Casa de Salud, Inc

  • Multi-Specialty Clinic/Center
  • Bronx, NY
  • NPI 1407225956
  NPD (past)

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327881600000",
    "number": "1023000353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 CLAY AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577239",
            "telephone_number": "718-299-1100",
            "fax_number": "718-299-4633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 CLAY AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104577239",
            "telephone_number": "718-299-1100",
            "fax_number": "718-299-4633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLYMORE",
        "first_name": "DAVID",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2012-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "225742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00665274",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicola Collins
• Nilijah Adia Collins
• Stanton Keith Collins, M.D.
• Terrence Collins
• Yvonne Collins
• Jamila Collymore
• Latoya Collymore
• Wavenie Collymore, RN
• Mariana Eugenia Colmenares
• Rodika Coloka-Kump, DO

• Pediatrics Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.