NPIMap

Individual provider Active NPI

Jerome Joseph Mikloucich, D.O.

  • Family Medicine Physician
  • Binghamton, NY
National Provider Identifier
1114059185
Registry record updated Jul 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
252865 Issued in NY
Practice address
276-280 Robinson St
Binghamton, NY 13904-1659
Phone
(607) 722-2769
NPI assigned
Mar 12, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2009

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 252865 NY Primary

Addresses

Primary practice location

276-280 Robinson St
Binghamton, NY 13904-1659

Mailing address

276-280 Robinson St
Binghamton, NY 13904-1659
Phone (607) 722-2769

Other identifiers 1

IdentifierTypeStateIssuer
03113559MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090603000054 NY Practitioner - Family PracticePractitioner - Geriatric Medicine 6800946450 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Our Lady of Lourdes Memorial Hospital IncGroup PAC ID 1254237779, 249 clinicians

Practice addresses (Care Compare)

169 Riverside Dr
G612
Binghamton, NY 13905-4246
Phone (607) 352-1735

Hospital & facility affiliations

  • Lourdes at Home Chha Home health agency, Vestal, NY, CCN 337415
  • Hospice at Lourdes, the Hospice, Vestal, NY, CCN 331505
  • Our Lady of Lourdes Memorial Hospital, Inc Hospital, Binghamton, NY, CCN 330011
  • Robert Packer Hospital Hospital, Sayre, PA, CCN 390079
  • United Health Services Hospitals, Inc Hospital, Binghamton, NY, CCN 330394
  • Chasehealth Rehab and Residential Care Nursing home, New Berlin, NY, CCN 335344
  • Good Shepherd Village at Endwell Nursing home, Endwell, NY, CCN 335859

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Jun 1, 2009 Accepting new patients
Twin Tier Pathology Associates, PC Current Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. Current Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. Family Medicine CurrentSince Jun 1, 2009 Accepting new patients
Eye Care Vision Optometry P.C. Past Accepting new patients
Umh JGJ Corp Past Accepting new patients
Good Shepherd Village at Endwell, Inc. Past Accepting new patients
Chase Memorial Nursing Home Co Inc Past Accepting new patients
Good Shepherd-Fairview Home, Inc. Past Accepting new patients

Locations

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

169 Riverside Dr
#G612
Binghamton, NY 13905
Phone (607) 352-1735

276-280 Robinson St
Binghamton, NY 13904
Phone (607) 722-2769

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

39 E Main St
Hancock, NY 13783
Phone (607) 637-5700

27 Jennison Ave
Johnson City, NY 13790
Phone (607) 729-0591

Interoperability endpoints

  • Direct secure messaging: jmikloucich194673@direct-guthrie.org

Organizations & group practices 9

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 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247788800000",
    "number": "1114059185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276-280 ROBINSON ST",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139041659",
            "telephone_number": "607-722-2769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276-280 ROBINSON ST",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139041659",
            "telephone_number": "607-722-2769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKLOUCICH",
        "first_name": "JEROME",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2009-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "252865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03113559",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Binghamton, NY

Sources for this page

Verify at the official NPI Registry.