Active NPI
Russell Joseph Mongiovi, DPM
- Sports Medicine Podiatrist
- Malta, NY
National Provider Identifier
1104852136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine Podiatrist
- License
- N004782
- Practice address
- 3 Hemphill PL
Malta, NY 12020-4419 - Phone
- (518) 899-3338
- Fax
- (518) 899-5025
- NPI assigned
- Jun 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine Podiatrist | 213ES0000X | N004782 | NY | Primary |
Addresses
Primary practice location
3 Hemphill PL
Malta, NY 12020-4419
Mailing address
3 Hemphill PL
Malta, NY 12020-4420
Phone (518) 899-3338
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080602000217 | NY | Practitioner - Podiatry | 6709956899 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Podiatry
- Education
- Kent State University College of Podiatric Medicine, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Spa Podiatry, PC
Practice addresses (Care Compare)
3 Hemphill PL
Suite 111
Ballston Spa, NY 12020-4420
Phone (518) 899-5338
Hospital & facility affiliations
- Saratoga Hospital
- Albany Medical Center Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 389 |
| Removal or shaving of skin growth | 189 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4782 | NY | MD | Acupuncturist |
| N004782 | NY | MD | Sports Medicine Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spa Podiatry, PC | Current | Accepting new patients | |
| Malta Foot Specialists | Sports Medicine | Past | Accepting new patients |
Locations
3 Hemphill Pl
Ste 111
Malta, NY 12020
Phone (518) 899-3338
Organizations & group practices 2
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 23
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Ambulatory Surgical Clinic/Center
- Niskayana, NY
- NPI 1154973071
Hospital
-
- Endocrinology, Diabetes & Metabolism Physician
- Gansevoort, NY
- NPI 1033371166
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104852136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 HEMPHILL PL",
"city": "MALTA",
"state": "NY",
"postal_code": "120204420",
"telephone_number": "518-899-3338",
"fax_number": "518-899-5025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 HEMPHILL PL",
"city": "MALTA",
"state": "NY",
"postal_code": "120204419",
"telephone_number": "518-899-3338",
"fax_number": "518-899-5025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONGIOVI",
"first_name": "RUSSELL",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0000X",
"taxonomy_group": "",
"desc": "Podiatrist, Sports Medicine",
"state": "NY",
"license": "N004782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malta, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.