NPIMap

Organization Active NPI

Prime Columbia Greene Medical Associates, PC

  • Internal Medicine Physician
  • Hudson, NY
National Provider Identifier
1093771677
Registry record updated Nov 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
209006 Issued in NY
Legal business name
PRIME COLUMBIA GREENE MEDICAL ASSOCIATES, PC
Practice address
949 Columbia St
Hudson, NY 12534-2624
Phone
(518) 828-7188
Fax
(518) 828-5049
NPI assigned
Apr 24, 2006
Last updated
Nov 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2011

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

Authorized official

Name
Clarence B Henry, MDNPI 1245232917
Title
President
Phone
(518) 828-7188

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 209006 NY Primary
Gastroenterology Physician 207RG0100X 109985 NY
Physical Medicine & Rehabilitation Physician 208100000X 123180 NY

Addresses

Primary practice location

949 Columbia St
Hudson, NY 12534-2624

Mailing address

949 Columbia St
Hudson, NY 12534-2624
Phone (518) 828-7188

Other identifiers 2

IdentifierTypeStateIssuer
02311659MedicaidNY
00195813MedicaidNY

National Provider Directory

National Provider Directory

Locations

159 Jefferson Hts
Ste D10
Catskill, NY 12414
Phone (518) 943-1442

Practitioners & affiliated clinicians

Practitioners 9

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": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320364800000",
    "number": "1093771677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 COLUMBIA ST",
            "city": "HUDSON",
            "state": "NY",
            "postal_code": "125342624",
            "telephone_number": "518-828-7188",
            "fax_number": "518-828-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "949 COLUMBIA ST",
            "city": "HUDSON",
            "state": "NY",
            "postal_code": "125342624",
            "telephone_number": "518-828-7188",
            "fax_number": "518-828-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME COLUMBIA GREENE MEDICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-24",
        "last_updated": "2011-11-04",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-828-7188",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "209006",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "109985",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "123180",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02311659",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00195813",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; 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.