Individual provider Active NPI

Marc Gibber

  • Otolaryngology Physician
  • Bronx, NY
National Provider Identifier
1063677599
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
268684 Issued in NY
Practice address
3400 Bainbridge Ave
Bronx, NY 10467-2404
Phone
(718) 920-8320
NPI assigned
Jul 24, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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
Otolaryngology Physician 207Y00000X 268684 NY Primary

Addresses

Primary practice location

3400 Bainbridge Ave
Bronx, NY 10467-2404

Mailing address

530 W End Ave Apt 1B
New York, NY 10024-3246
Phone (516) 314-4640

Other practice location 1

First Ave. & 16th St.
new york, NY 10003
Phone (212) 420-4340

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
I20140410000331 NY Practitioner - Otolaryngology 5698907426 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Albert Einstein College of Medicine of Yeshiva University, 2008
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

3400 Bainbridge Ave
Bronx, NY 10467-2404
Phone (914) 378-6148

Hospital & facility affiliations

  • Montefiore Medical Center Hospital, Bronx, NY, CCN 330059

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
268684NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Otolaryngology CurrentSince Aug 16, 2013 Accepting new patients
Montefiore Medical Center CurrentSince Aug 16, 2013 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

555 Taxter Rd
Fl 3
Elmsford, NY 10523
Phone (914) 457-4130

555 Taxter Rd
Elmsford, NY 10523
Phone (718) 920-2587

Networks

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

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1063677599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 W END AVE APT 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100243246",
            "telephone_number": "516-314-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 BAINBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672404",
            "telephone_number": "718-920-8320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "First Ave. & 16th St.",
            "address_purpose": "LOCATION",
            "city": "new york",
            "state": "NY",
            "postal_code": "10003",
            "country_code": "US",
            "telephone_number": "212-420-4340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBBER",
        "first_name": "MARC",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-24",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "268684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.