NPIMap

Organization Active NPI

Port Jervis Family Health NP PC

  • Primary Care Clinic/Center
  • Port Jervis, NY
National Provider Identifier
1063927358
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
337610 Issued in NY
Legal business name
PORT JERVIS FAMILY HEALTH NP PC
Practice address
1 Cole St
Port Jervis, NY 12771-2217
Phone
(845) 856-6671
Fax
(845) 856-6671
NPI assigned
Dec 8, 2017
Last updated
Jul 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Authorized official

Name
Michele M Doyle, FNPNPI 1942551890
Title
Nurse Practitioner/Owner
Phone
(845) 856-6671

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 337610 NY Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

1 Cole St
Port Jervis, NY 12771-2217

Mailing address

7 Surrey Rd
Chester, NY 10918-1106
Phone (845) 325-8378

Other identifiers 4

IdentifierTypeStateIssuer
1902344492MedicaidNY
1035162650001MedicaidPA
1942551890MedicaidNY
05103104MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231107001544 NY Part B Supplier - Clinic/Group Practice 3971950387 Receives reassigned benefits from 1 practitioner
Practice locations: Port Jervis, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1512691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1063927358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 SURREY RD",
            "city": "CHESTER",
            "state": "NY",
            "postal_code": "109181106",
            "telephone_number": "845-325-8378",
            "fax_number": "845-858-9903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COLE ST",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127712217",
            "telephone_number": "845-856-6671",
            "fax_number": "845-856-6671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT JERVIS FAMILY HEALTH NP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-08",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "DOYLE",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "845-856-6671",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "337610",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902344492",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1035162650001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942551890",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05103104",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jervis, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; 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.