Organization Active NPI

Ny Kidney Hypertension, PLLC

  • Nephrology Physician
  • Bronx, NY
National Provider Identifier
1063685436
Registry record updated Oct 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
211368 Issued in NY
Legal business name
NY KIDNEY HYPERTENSION, PLLC
Practice address
3322 Bainbridge Ave
Bronx, NY 10467-2849
Phone
(718) 881-2100
Fax
(718) 881-5164
NPI assigned
Apr 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2012

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

Authorized official

Name
Dr. Micheal R. Guccione, MD
Title
President
Phone
(718) 881-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 211368 NY Primary

Addresses

Primary practice location

3322 Bainbridge Ave
Bronx, NY 10467-2849

Mailing address

PO Box 1042
Ridgefield, CT 06877-9042
Phone (718) 881-2100

Other identifiers 1

IdentifierTypeStateIssuer
02560850MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060109000732 NY Part B Supplier - Clinic/Group Practice 0840213542 Receives reassigned benefits from 1 practitioner
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1063685436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1042",
            "city": "RIDGEFIELD",
            "state": "CT",
            "postal_code": "068779042",
            "telephone_number": "718-881-2100",
            "fax_number": "718-881-5164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 BAINBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672849",
            "telephone_number": "718-881-2100",
            "fax_number": "718-881-5164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NY KIDNEY HYPERTENSION, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-08",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "GUCCIONE",
        "authorized_official_first_name": "MICHEAL",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-881-2100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "211368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02560850",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.