Individual provider Active NPI

Traci Toll-Griffin, MD

  • Pediatrics Physician
  • Brewster, NY
National Provider Identifier
1063467520
Registry record updated Nov 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
214615 Issued in NY
Practice address
Mount Kisco Medical Group, PC
Southeast Executive Park, 185 Route 312
Brewster, NY 10509
Phone
(845) 278-7000
Fax
(914) 242-1516
NPI assigned
May 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 214615 NY Primary

Addresses

Primary practice location

Mount Kisco Medical Group, PC
Southeast Executive Park, 185 Route 312
Brewster, NY 10509

Mailing address

Mount Kisco Medical Group, PC
90 South Bedford Road
Mount Kisco, NY 10549-3412
Phone (914) 241-1050

Other identifiers 1

IdentifierTypeStateIssuer
02153088MedicaidNY

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
I20100104000379 NY Practitioner - Pediatric Medicine 1052452794 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians

Practice addresses (Care Compare)

90 S Bedford Rd
Mount Kisco, NY 10549-3412
Phone (914) 241-1050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
214615NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Nov 18, 2009 Accepting new patients
Optum Medical Care, P.C. CurrentSince Nov 18, 2009 Accepting new patients

Locations

185 Route 312
Brewster, NY 10509
Phone (845) 225-2700

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

Philadelphia, PA 19195

Networks

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

Interoperability endpoints

  • Direct secure messaging: ttollgriffin143668@direct.optum.com

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259107200000",
    "number": "1063467520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MOUNT KISCO MEDICAL GROUP, PC",
            "address_2": "90 SOUTH BEDFORD ROAD",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105493412",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MOUNT KISCO MEDICAL GROUP, PC",
            "address_2": "SOUTHEAST EXECUTIVE PARK, 185 ROUTE 312",
            "city": "BREWSTER",
            "state": "NY",
            "postal_code": "10509",
            "telephone_number": "845-278-7000",
            "fax_number": "914-242-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLL-GRIFFIN",
        "first_name": "TRACI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2009-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "214615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02153088",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brewster, NY

Sources for this page

Verify at the official NPI Registry.