Individual provider Active NPI

Keith Thomas Diaz, M.D.

  • Pulmonary Disease Physician
  • Staten Island, NY
National Provider Identifier
1073771556
Registry record updated Sep 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
245968 Issued in NY
Practice address
682 Forest Ave
Staten Island, NY 10310-2507
Phone
(347) 575-9865
NPI assigned
May 30, 2008
Last updated
Sep 8, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 245968 NY
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 245968 NY
Pulmonary Disease Physician 207RP1001X 245968 NY Primary

Addresses

Primary practice location

682 Forest Ave
Staten Island, NY 10310-2507

Mailing address

474 Bedford Ave
Staten Island, NY 10306-5424
Phone (347) 575-9865

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
I20110830000119 NY Practitioner - Internal MedicinePractitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 2860661121 Reassigns benefits to 3 organizations
Practice locations: Staten Island, NY

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Critical Care (Intensivists)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Amboy Medical Practice PCGroup PAC ID 2860538170, 171 clinicians

Practice addresses (Care Compare)

1058 Forest Ave
Staten Island, NY 10310-2419
Phone (718) 818-1058

355 Bard Ave
Staten Island, NY 10310-1664

4434 Amboy Rd
Staten Island, NY 10312-3845
Phone (718) 984-9658

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Amboy Medical Practice PC CurrentSince Jan 15, 2012 Accepting new patients
Ny Medical Health Care Diagnostic, PC CurrentSince Aug 20, 2019 Accepting new patients
Amboy Medical Practice PC Internal Medicine CurrentSince Jan 15, 2012 Accepting new patients
Westchester Medical Center Advanced Physician Services PC CurrentSince Feb 28, 2024 Accepting new patients
Westchester Medical Center Advanced Physician Services, PC CurrentSince Feb 28, 2024 Accepting new patients
Richmond Medical Center Past Accepting new patients

Locations

2615 E 16th St
Fl 2
Brooklyn, NY 11235
Phone (347) 415-7347

19 Bradhurst Ave
Ste 3100N
Hawthorne, NY 10532
Phone (914) 231-8373

1058 Forest Ave
Staten Island, NY 10310
Phone (718) 818-1058

355 Bard Ave
Fl SLB2
Staten Island, NY 10310
Phone (718) 818-4450

355 Bard Ave
Fl SLB2SICU
Staten Island, NY 10310
Phone (718) 818-4450

4434 Amboy Rd
Staten Island, NY 10312
Phone (718) 818-1015

95 Grasslands Rd
Valhalla, NY 10595
Phone (914) 493-2961

Networks

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

Interoperability endpoints

  • Direct secure messaging: keith.diaz.1@19656.direct.athenahealth.com

Organizations & group practices 7

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 8

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": "1212105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410134400000",
    "number": "1073771556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 BEDFORD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103065424",
            "telephone_number": "347-575-9865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "682 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103102507",
            "telephone_number": "347-575-9865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "KEITH",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-30",
        "last_updated": "2014-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "245968",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NY",
            "license": "245968",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "245968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.