Individual provider Active NPI

John Mark Craig, PA

  • Physician Assistant
  • Poughkeepsie, NY
National Provider Identifier
1083845010
Registry record updated Aug 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001095 Issued in NY
Practice address
124 Raymond Ave
Poughkeepsie, NY 12604-0001
Phone
(845) 437-5800
Fax
(845) 437-7135
NPI assigned
Aug 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001095 NY Primary

Addresses

Primary practice location

124 Raymond Ave
Poughkeepsie, NY 12604-0001

Mailing address

124 Raymond Ave
Poughkeepsie, NY 12604-0001
Phone (845) 437-5800

Other identifiers 1

IdentifierTypeStateIssuer
001095OtherNYNYS LICENSE NUMBER 001095

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150318000167 NY Practitioner - Physician Assistant 9739406463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Pennsylvania State University College of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Westchester Medical Center Advanced Physician Services PCGroup PAC ID 3173660776, 879 clinicians

Practice addresses (Care Compare)

241 N Rd
Poughkeepsie, NY 12601-1154
Phone (845) 483-5000

95 Grasslands Rd
Valhalla, NY 10595-1652
Phone (914) 493-6940

Hospital & facility affiliations

  • Westchester Medical Center Hospital, Valhalla, NY, CCN 330234

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001095NYMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Westchester Medical Center Advanced Physician Services PC CurrentSince Jan 21, 2017 Accepting new patients
Westchester County Health Care Corporation Past Accepting new patients

Locations

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

241 North Rd
Poughkeepsie, NY 12601
Phone (845) 431-8889

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

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Organizations & group practices 3

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 1

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": "1249689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249689600000",
    "number": "1083845010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 RAYMOND AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126040001",
            "telephone_number": "845-437-5800",
            "fax_number": "845-437-7135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 RAYMOND AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126040001",
            "telephone_number": "845-437-5800",
            "fax_number": "845-437-7135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAIG",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-08",
        "last_updated": "2009-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "001095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE NUMBER  001095",
            "identifier": "001095",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

Verify at the official NPI Registry.