NPIMap

Organization Active NPI

State of New York

  • Case Management Agency
  • Tupper Lake, NY
National Provider Identifier
1083899702
Registry record updated Jul 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
CAH00018 Issued in NY
Legal business name
STATE OF NEW YORK
Practice address
2445 State Route 30
Tupper Lake, NY 12986-2502
Phone
(518) 457-9835
NPI assigned
Dec 31, 2007
Last updated
Jul 21, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF NEW YORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2015

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

Authorized official

Name
Earl Jefferson
Title
Director of Central Operations
Phone
(518) 402-4333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X CAH00018 NY Primary

Addresses

Primary practice location

2445 State Route 30
Tupper Lake, NY 12986-2502

Mailing address

44 Holland Ave
Albany, NY 12229-0001
Phone (518) 402-4333

Other names 1

  • CAH Sunmount DDSO Other name

National Provider Directory

National Provider Directory
Tax ID family
Monroe Ddso Clinic University269 organizations share this tax ID, including this one
Part of
Monroe Ddso Clinic University

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2445 State Route 30
Tupper Lake, NY 12986
Phone (518) 359-3311

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437436800000",
    "number": "1083899702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 HOLLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122290001",
            "telephone_number": "518-402-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2445 STATE ROUTE 30",
            "city": "TUPPER LAKE",
            "state": "NY",
            "postal_code": "129862502",
            "telephone_number": "518-457-9835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW YORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF NEW YORK",
        "enumeration_date": "2007-12-31",
        "last_updated": "2015-07-21",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "EARL",
        "authorized_official_title_or_position": "DIRECTOR OF CENTRAL OPERATIONS",
        "authorized_official_telephone_number": "518-402-4333"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NY",
            "license": "CAH00018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CAH Sunmount DDSO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tupper Lake, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.