Individual provider Active NPI

Theresa Maria Pereguda, M.D.

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1023309408
Registry record updated Nov 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
273864-1 Issued in NY
Practice address
423 E 23Rd St
VA New York Harbor Healthcare System
New York, NY 10010-5011
Phone
(212) 686-7500
NPI assigned
Apr 20, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 273864-1 NY Primary

Addresses

Primary practice location

423 E 23Rd St
VA New York Harbor Healthcare System
New York, NY 10010-5011

Mailing address

423 E 23Rd St
VA New York Harbor Healthcare System
New York, NY 10010-5011
Phone (212) 686-7500

Other names 1

  • Theresa Maria Sumberac Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140917000285 NY Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 0941429302

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
273864-1NYMDAdult Psychiatric/Mental Health Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1303257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478563200000",
    "number": "1023309408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 E 23RD ST",
            "address_2": "VA NEW YORK HARBOR HEALTHCARE SYSTEM",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100105011",
            "telephone_number": "212-686-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 E 23RD ST",
            "address_2": "VA NEW YORK HARBOR HEALTHCARE SYSTEM",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100105011",
            "telephone_number": "212-686-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREGUDA",
        "first_name": "THERESA",
        "middle_name": "MARIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-20",
        "last_updated": "2016-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "273864-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "SUMBERAC",
            "middle_name": "MARIA",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.