Organization Active NPI

Tri-City Cardiology Care, PLLC

  • Cardiovascular Disease Physician
  • Troy, NY
National Provider Identifier
1104258342
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
TRI-CITY CARDIOLOGY CARE, PLLC
Practice address
258 Hoosick St
Suite 107
Troy, NY 12180-2444
Phone
(518) 322-5295
NPI assigned
Jul 30, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Authorized official

Name
Dr. Hussain Khawajah, MD
Title
Owner
Phone
(518) 322-5295

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

258 Hoosick St
Suite 107
Troy, NY 12180-2444

Mailing address

258 Hoosick St
Suite 107
Troy, NY 12180-2444
Phone (518) 322-5295

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131112000246 NY Part B Supplier - Clinic/Group Practice 8628204161 Receives reassigned benefits from 1 practitioner
Practice locations: Troy, NY

National Provider Directory

National Provider Directory

Locations

258 Hoosick St
Ste 107
Troy, NY 12180
Phone (518) 322-5295

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1375142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1104258342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 HOOSICK ST",
            "address_2": "SUITE 107",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121802444",
            "telephone_number": "518-322-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 HOOSICK ST",
            "address_2": "SUITE 107",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121802444",
            "telephone_number": "518-322-5295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-CITY CARDIOLOGY CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-30",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "KHAWAJAH",
        "authorized_official_first_name": "HUSSAIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-322-5295",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.