Individual provider Active NPI

Soon-Il Song, M.D.

  • Internal Medicine Physician
  • Rochester, NY
National Provider Identifier
1063464386
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
260927 Issued in NY
Practice address
82 Holland St
Rochester, NY 14605-2131
Phone
(585) 423-5800
Fax
(585) 423-2890
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 260927 NY Primary

Addresses

Primary practice location

82 Holland St
Rochester, NY 14605-2131

Mailing address

214C Lake Ave
Rochester, NY 14608-1208
Phone (585) 423-5800

Other identifiers 1

IdentifierTypeStateIssuer
03361960MedicaidNY

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
I20110802000424 NY Practitioner - Internal Medicine 1759381213 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rochester General HospitalGroup PAC ID 0244149474, 1,192 clinicians

Practice addresses (Care Compare)

1425 Portland Ave
Rochester, NY 14621-3011
Phone (585) 922-4000

1455 E Ridge Rd
Rochester, NY 14621-2006
Phone (585) 922-5033

Hospital & facility affiliations

  • Rochester General Hospital Hospital, Rochester, NY, CCN 330125

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
260927NYMDPsychiatric Hospital

Practice roles

OrganizationSpecialtyStatusNew patients
Rochester General Hospital CurrentSince Apr 1, 2021 Accepting new patients
Rochester General Hospital Internal Medicine CurrentSince Apr 1, 2021 Accepting new patients

Locations

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

601 Elmwood Ave
Rochester, NY 14642
Phone (585) 275-9555

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1063464386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214C LAKE AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146081208",
            "telephone_number": "585-423-5800",
            "fax_number": "585-423-2890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 HOLLAND ST",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146052131",
            "telephone_number": "585-423-5800",
            "fax_number": "585-423-2890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "SOON-IL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "260927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03361960",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.