NPIMap

Individual provider Active NPI

Renata N Mazzei -Klokiw, MD

  • Family Medicine Physician
  • Clifton Park, NY
National Provider Identifier
1073583738
Registry record updated Apr 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
229963 Issued in NY
Practice address
103 Sitterly Road
Suite 2300
Clifton Park, NY 12065-1026
Phone
(518) 579-2650
Fax
(518) 579-2670
NPI assigned
Jan 25, 2006
Last updated
Apr 5, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 229963 NY Primary

Addresses

Primary practice location

103 Sitterly Road
Suite 2300
Clifton Park, NY 12065-1026

Mailing address

103 Sitterly Road
Suite 2300
Clifton Park, NY 12065-1026
Phone (518) 579-2650

Other identifiers 11

IdentifierTypeStateIssuer
000000084125OtherNYGHI-HMO
040426006874OtherNYFIDELIS
P00196354OtherRAILROAD MEDICARE
11316316OtherCAQH
9744189OtherNYGHI-PPO
02600448MedicaidNY
400762OtherNYMVP
4282N1OtherNYBLUE CROSS
7843670OtherNYAETNA
000404963001OtherNYBLUE SHIELD/HEALTHNOW
10076504OtherNYCDPHP

Other names 1

  • Renata Nicoletta Mazzei Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040122000380 NY Practitioner - Family Practice 0446152383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ellis HospitalGroup PAC ID 5890607410, 250 clinicians

Practice addresses (Care Compare)

103 Sitterly Rd
Halfmoon, NY 12065-5612
Phone (518) 579-2800

1101 Nott St
Schenecctady, NY 12308-2425
Phone (518) 243-4000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ellis Hospital Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522886400000",
    "number": "1073583738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SITTERLY ROAD",
            "address_2": "SUITE 2300",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120651026",
            "telephone_number": "518-579-2650",
            "fax_number": "518-579-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SITTERLY ROAD",
            "address_2": "SUITE 2300",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120651026",
            "telephone_number": "518-579-2650",
            "fax_number": "518-579-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZEI -KLOKIW",
        "first_name": "RENATA",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2018-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "229963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI-HMO",
            "identifier": "000000084125",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "040426006874",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00196354",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11316316",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI-PPO",
            "identifier": "9744189",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02600448",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "400762",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4282N1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7843670",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD/HEALTHNOW",
            "identifier": "000404963001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10076504",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RENATA",
            "last_name": "MAZZEI",
            "middle_name": "NICOLETTA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Clifton Park, NY

Sources for this page

Verify at the official NPI Registry.