NPIMap

Individual provider Active NPI

Charles Allen Mitgang, M.D.

  • Internal Medicine Physician
  • Rockville Centre, NY
National Provider Identifier
1114923315
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
127551 Issued in NY
Practice address
371 Merrick Rd
Ste 302
Rockville Centre, NY 11570-5301
Phone
(516) 678-5555
Fax
(516) 678-9128
NPI assigned
Jun 22, 2005
Last updated
Jun 11, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 127551 NY Primary

Addresses

Primary practice location

371 Merrick Rd
Ste 302
Rockville Centre, NY 11570-5301

Mailing address

371 Merrick Rd
Ste 302
Rockville Centre, NY 11570-5301
Phone (516) 678-5555

Other identifiers 1

IdentifierTypeStateIssuer
00425347MedicaidNY

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
I20081212000165 NY Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology)Practitioner - Family Practice 7618038324 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
State University of New York Downstate Medical Center, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Charles a. Mitgang, M.D. P.C.Group PAC ID 6709948417, 2 clinicians

Practice addresses (Care Compare)

371 Merrick Rd
Suite 407
Rockville Centre, NY 11570-5301
Phone (516) 678-5555

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
23.76 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
79.19

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Internal Medicine PC Internal Medicine CurrentSince Jan 1, 2008 Accepting new patients
Mercy Medical Center Past Accepting new patients

Locations

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1114923315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 MERRICK RD",
            "address_2": "STE 302",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115705301",
            "telephone_number": "516-678-5555",
            "fax_number": "516-678-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 MERRICK RD",
            "address_2": "STE 302",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115705301",
            "telephone_number": "516-678-5555",
            "fax_number": "516-678-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITGANG",
        "first_name": "CHARLES",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "127551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00425347",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

Verify at the official NPI Registry.