Individual provider Active NPI

Innesa Sarkisova, M.D.

  • Family Medicine Physician
  • Schenectady, NY
National Provider Identifier
1083064943
Registry record updated Feb 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
300980 Issued in NY
Practice address
624 McClellan St
Suite 101
Schenectady, NY 12304-1020
Phone
(518) 347-5293
Fax
(518) 347-5196
NPI assigned
Jun 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2020

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 300980 NY Primary

Addresses

Primary practice location

624 McClellan St
Suite 101
Schenectady, NY 12304-1020

Mailing address

624 McClellan St
Suite 101
Schenectady, NY 12304-1020
Phone (518) 347-5293

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
I20191203001039 NY Practitioner - Family Practice 6103259361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ellis HospitalGroup PAC ID 5890607410, 250 clinicians

Practice addresses (Care Compare)

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

1201 Nott St
Schenectady, NY 12308-2589
Phone (518) 243-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
300980NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ellis Hospital CurrentSince Nov 13, 2019 Accepting new patients

Locations

600 McClellan St
Schenectady, NY 12304
Phone (518) 382-2000

1201 Nott St
Ste 204
Schenectady, NY 12308
Phone (518) 243-3388

1101 Nott St
Schenectady, NY 12308
Phone (518) 243-1916

624 McClellan St
Ste 101
Schenectady, NY 12304
Phone (518) 347-5043

Organizations & group practices 1

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 3

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": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1083064943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN ST",
            "address_2": "SUITE 101",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-347-5293",
            "fax_number": "518-347-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN ST",
            "address_2": "SUITE 101",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-347-5293",
            "fax_number": "518-347-5196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARKISOVA",
        "first_name": "INNESA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-21",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "300980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.