NPIMap

Organization Active NPI

Newyork-Presbyterian-Queens

Doing business as Trude Weishaupt Memorial Satellite Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fresh Meadows, NY
National Provider Identifier
1023053527
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
7003010H PFI 2670 Issued in NY
Legal business name
NEWYORK-PRESBYTERIAN-QUEENS
Doing business as
Trude Weishaupt Memorial Satellite Dialysis Center
Practice address
5928 174TH St
Fresh Meadows
Fresh Meadows, NY 11365-1539
Phone
(718) 670-1276
NPI assigned
Jun 18, 2006
Last updated
Oct 3, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
NYP COMMUNITY PROGRAMS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Authorized official

Name
Mrs. Phyllis R.F. Lantos
Title
Evp, Cfo and Treasurer
Phone
(212) 746-7905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 7003010H PFI 2670 NY Primary

Addresses

Primary practice location

5928 174TH St
Fresh Meadows
Fresh Meadows, NY 11365-1539

Mailing address

5928 174TH St
Fresh Meadows
Fresh Meadows, NY 11365-1539
Phone (718) 670-1276

Other identifiers 2

IdentifierTypeStateIssuer
333547OtherNYMEDICARE PTAN
00244133MedicaidNY

Other names 1

  • Trude Weishaupt Memorial Satellite Dialysis Center Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170213000121 NY Part A Provider - End-Stage Renal Disease Facility (ESRD) 7315839933 Practice locations: Fresh Meadows, NY

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

18219 Horace Harding Expy
New York, NY 10087

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1023053527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5928 174TH ST",
            "address_2": "FRESH MEADOWS",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113651539",
            "telephone_number": "718-670-1276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5928 174TH ST",
            "address_2": "FRESH MEADOWS",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113651539",
            "telephone_number": "718-670-1276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWYORK-PRESBYTERIAN-QUEENS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NYP COMMUNITY PROGRAMS, INC.",
        "enumeration_date": "2006-06-18",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "LANTOS",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "R.F.",
        "authorized_official_title_or_position": "EVP, CFO AND TREASURER",
        "authorized_official_telephone_number": "212-746-7905",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "7003010H PFI 2670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "333547",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00244133",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "5928 174th St",
            "address_2": "Fresh Meadows",
            "city": "Fresh Meadows",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113651539",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "5928 174th St",
            "address_2": "Fresh Meadows",
            "city": "Fresh Meadows",
            "state": "NY",
            "country_code": "US",
            "postal_code": "113651539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Trude Weishaupt Memorial Satellite Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Trude Weishaupt Memorial Satellite Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresh Meadows, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.