Theodore Antonetz, D.P.M.
Individual provider Active NPI Podiatrist · Nyc, NY
NPI 1083714554 · NPPES record last updated Aug 6, 2010
Key facts
- NPI
- 1083714554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- N004056 (NY)
- Practice address
- 185 West End Avenue
Suite 1N
Nyc, NY 10023 - Phone
- (212) 877-3062
- Fax
- (212) 873-9521
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 12
Other NPIs with the same Medicare PAC ID 1
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- New York College of Podiatric Medicine, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hudson Valley Foot Associates LLP
Boltrope Podiatry Ny PLLC
Middletown Medical PC
Practice addresses (Care Compare)
103 Hurley Ave
Kingston, NY 12401-2829
Phone (845) 339-4191
111 Maltese Dr
Middletown, NY 10940-2115
Phone (845) 342-4774
185 W End Ave
Apt 1N
New York, NY 10023-5540
Phone (212) 877-3062
365 W Passaic St
Suite 530
Rochelle Park, NJ 07662-3012
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.92 of 100
- Quality
- 68.46
- Promoting interoperability
- 99
- Improvement activities
- 40
- Cost
- 77.61
Merit-based Incentive Payment System (MIPS)
- Final score
- 44.17 of 100
- Quality
- 88.33
- Improvement activities
- 0
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 41 |
| Removal of skin lesions | 62 |
| Removal of nail tissue | 1035 |
| Removal or shaving of skin growth | 399 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110120000879 | NY | Practitioner - Podiatry | 2769504182 | Reassigns benefits to 4 organizations |
| I20251107004015 | NY | Practitioner - Podiatry | 2769504182 | Reassigns benefits to 1 organization |
| O20100930078930 | NY | DME Supplier - Physician - Podiatry | 7810018215 | Practice locations: New York, NY |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004056 | NY | MD | Behavioral Analyst |
| N004056 | NY | MD | Podiatrist |
Practice roles (7 of 11)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hudson Valley Foot Associates, LLP | Current |
Accepting new patients | |
| Middletown Medical PC | Current |
Accepting new patients | |
| Dr. Theodore Antonetz, DPM, PC | Podiatrist | Current |
Accepting new patients |
| Cur Alta Medical Ny PLLC | Podiatrist | Current |
Accepting new patients |
| Middletown Medical PC | Current |
Accepting new patients | |
| Cur Alta Medical Ny PLLC | Podiatrist | Current |
Accepting new patients |
| Hudson Valley Foot Associates, LLP | Current |
Accepting new patients |
Locations
3117 Ditmars Blvd
Ste A
Astoria, NY 11105
Phone (718) 274-4040
6357 108th St
Forest Hills, NY 11375
Phone (718) 896-6369
3433 US Highway 9W
Highland, NY 12528
Phone (845) 339-3338
103 Hurley Ave
Kingston, NY 12401
Phone (845) 339-4191
111 Maltese Dr
Middletown, NY 10940
111 Main St
Nanuet, NY 10954
Phone (845) 623-5863
185 W End Ave
Apt 1N
New York, NY 10023
Phone (212) 580-8680
1323 Route 9
Ste 106
Wappingers Fl, NY 12590
Phone (845) 297-4055
8612 Jamaica Ave
Woodhaven, NY 11421
Phone (718) 846-7872
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
Interoperability endpoints
- https://fhir.meditouchehr.com/api/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | N004056 | NY | Yes |
Addresses
Primary practice location
185 West End Avenue
Suite 1N
Nyc, NY 10023
Mailing address
185 West End Avenue
Suite 1N
Nyc, NY 10023
Phone (212) 877-3062
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P43851 | Other | NY | BLUE CROSS/BLUE SHIELD |
Other providers in Nyc, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.