Individual provider Active NPI

Fernand F Theogene, M.D

  • Family Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1093771206
Registry record updated Jul 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
196985 Issued in NY
Practice address
650 Ashford St
Brooklyn, NY 11207-7315
Phone
(718) 345-5000
Fax
(718) 345-5794
NPI assigned
Apr 25, 2006
Last updated
Jul 9, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2018

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 196985 NY Primary

Addresses

Primary practice location

650 Ashford St
Brooklyn, NY 11207-7315

Mailing address

592 Rockaway Ave
Brooklyn, NY 11212-5539
Phone (718) 345-5000

Other identifiers 1

IdentifierTypeStateIssuer
01847281MedicaidNY

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
I20110809000088 NY Practitioner - Family Practice 1355510348 Reassigns benefits to 5 organizations
Practice locations: Brooklyn, NY

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
196985NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital, Inc. Family Medicine Current Accepting new patients
Bronx Medical Practice P.C. CurrentSince Jan 2, 2024 Accepting new patients
Essen Medical Associates, PC Current Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. CurrentSince Apr 21, 2021 Accepting new patients
Essen Medical Associates,PC CurrentSince Jan 2, 2024 Accepting new patients
Essen Medical Associates, PC CurrentSince Jan 2, 2024 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Apr 21, 2021 Accepting new patients
Twin Tier Pathology Associates, PC Current Accepting new patients
Essen Medical Urgicare, PLLC CurrentSince Jan 2, 2024 Accepting new patients
House Call Medical Services of New York, PLLC CurrentSince Jan 2, 2024 Accepting new patients
A & Q Medical Care PLLC Past Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

1371 Seabury Ave
Bronx, NY 10461
Phone (718) 294-6200

1550 Dr Martin L King Jr Blvd
Bronx, NY 10452
Phone (347) 269-2366

2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

8989 Union Tpke
Glendale, NY 11385
Phone (718) 480-6207

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

500 5th Ave
Owego, NY 13827
Phone (607) 687-1122

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1093771206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "592 ROCKAWAY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112125539",
            "telephone_number": "718-345-5000",
            "fax_number": "718-345-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 ASHFORD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112077315",
            "telephone_number": "718-345-5000",
            "fax_number": "718-345-5794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOGENE",
        "first_name": "FERNAND",
        "middle_name": "F",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "196985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01847281",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.