NPIMap

Organization Active NPI

Optum Infusion Services 100, Inc.

  • Home Infusion Agency
  • Farmingdale, NY
National Provider Identifier
1043275969
Registry record updated Sep 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion AgencyTaxonomy code 251F00000X
License
9296L0001 Issued in NY
Legal business name
OPTUM INFUSION SERVICES 100, INC.
Practice address
931 D Conklin Street
Farmingdale, NY 11735
Phone
(800) 346-6348
Fax
(866) 689-3569
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2021

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

Authorized official

Name
David Oberg
Title
VP, Compliance
Phone
(499) 988-5893

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X 9296L0001 NY Primary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 020477 NY

Addresses

Primary practice location

931 D Conklin Street
Farmingdale, NY 11735

Mailing address

931 D Conklin Street
Farmingdale, NY 11735
Phone (800) 346-6348

Other identifiers 6

IdentifierTypeStateIssuer
85329OtherNYMVP
ANC1772OtherNYOXFORD
9296L001OtherNYHOME CARE SERVICE AGENCY LICENSE
58658OtherNYVYTRA
B6A532OtherNYEMPIRE BC/BS
114382OtherNYAETNA

National Provider Directory

National Provider Directory
Tax ID family
Optum Infusion Services 1002 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15529 College Blvd
Lenexa, KS 66219
Phone (877) 342-9352

931 Conklin St
Ste D
Farmingdale, NY 11735
Phone (631) 391-9670

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 8

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": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632268800000",
    "number": "1043275969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 D CONKLIN STREET",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "11735",
            "telephone_number": "800-346-6348",
            "fax_number": "866-689-3569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 D CONKLIN STREET",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "11735",
            "telephone_number": "800-346-6348",
            "fax_number": "866-689-3569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM INFUSION SERVICES 100, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A",
        "authorized_official_last_name": "OBERG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP, COMPLIANCE",
        "authorized_official_telephone_number": "499-988-5893"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "NY",
            "license": "9296L0001",
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "NY",
            "license": "020477",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "85329",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "ANC1772",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME CARE SERVICE AGENCY LICENSE",
            "identifier": "9296L001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA",
            "identifier": "58658",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC/BS",
            "identifier": "B6A532",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "114382",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmingdale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; 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.