Individual provider Active NPI

Jeffrey L. Rockmore, M.D.

  • Specialist
  • Latham, NY
National Provider Identifier
1104899632
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
202795-1 Issued in NY
Practice address
15 Old Loudon Rd
Latham, NY 12110-5242
Phone
(518) 328-3330
NPI assigned
Feb 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 202795-1 NY Primary

Addresses

Primary practice location

15 Old Loudon Rd
Latham, NY 12110-5242

Mailing address

15 Old Loudon Rd
Latham, NY 12110-5242
Phone (518) 328-3330

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
I20110326000066 NY Practitioner - Plastic and Reconstructive Surgery 2769411040 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
202795NYMDLicensed Practical Nurse
202795-1NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Plastic Surgery Associates LLP Specialist CurrentSince Mar 20, 2012 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

455 Patroon Creek Blvd
Ste 101
Albany, NY 12206
Phone (518) 438-0505

1365 Washington Ave
Ste 200
Albany, NY 12206
Phone (518) 264-1761

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.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1104899632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 OLD LOUDON RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121105242",
            "telephone_number": "518-328-3330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 OLD LOUDON RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121105242",
            "telephone_number": "518-328-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROCKMORE",
        "first_name": "JEFFREY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "202795-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

Verify at the official NPI Registry.