Organization Active NPI

Seaway Radiology PC

  • Diagnostic Radiology Physician
  • Alexandria Bay, NY
National Provider Identifier
1124012018
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
198556 Issued in NY
Legal business name
SEAWAY RADIOLOGY PC
Practice address
4 Fuller St
Alexandria Bay, NY 13607-1316
Phone
(315) 482-2511
NPI assigned
Sep 7, 2005
Last updated
Apr 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Authorized official

Name
Dr. Ali M Gharagozloo, M.D.NPI 1437142239
Title
Medical Director of Group
Phone
(315) 393-1215

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 198556 NY Primary

Addresses

Primary practice location

4 Fuller St
Alexandria Bay, NY 13607-1316

Mailing address

27 Dockside Dr # 27
Morristown, NY 13664-3231
Phone (315) 482-2511

Other identifiers 1

IdentifierTypeStateIssuer
02728623MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA, NC, OH, MA, FL, PA, CO, AZ9 enrollments

Enrollment records 9

Enrollment IDStateProvider typePAC IDDetails
O20040518001496 NY Part B Supplier - Clinic/Group Practice 6305837584 Receives reassigned benefits from 6 practitioners
Practice locations: Alexandria Bay, NY; Ithaca, NY; Jericho, NY; Watertown, NY
O20150829000189 CA Part B Supplier - Clinic/Group Practice 6305837584 Receives reassigned benefits from 1 practitioner
Practice locations: Santa Monica, CA
O20201015002109 NC Part B Supplier - Clinic/Group Practice 6305837584 Receives reassigned benefits from 1 practitioner
Practice locations: Saluda, NC
O20230502001288 OH Part B Supplier - Clinic/Group Practice 6305837584 Receives reassigned benefits from 2 practitioners
Practice locations: Portsmouth, OH; Dublin, OH
O20230505002001 MA Part B Supplier - Clinic/Group Practice 6305837584 Receives reassigned benefits from 1 practitioner
Practice locations: Newburyport, MA
O20230508000975 FL Part B Supplier - Clinic/Group Practice 6305837584 Receives reassigned benefits from 3 practitioners
Practice locations: Fort Lauderdale, FL; Palm City, FL; Port St Lucie, FL
O20230508001130 PA Part B Supplier - Clinic/Group Practice 6305837584 Receives reassigned benefits from 1 practitioner
Practice locations: Phoenixville, PA
O20240124000167 CO Part B Supplier - Clinic/Group Practice 6305837584 Receives reassigned benefits from 1 practitioner
Practice locations: Colorado Springs, CO
O20240731000491 AZ Part B Supplier - Clinic/Group Practice 6305837584 Receives reassigned benefits from 1 practitioner
Practice locations: Cave Creek, AZ

National Provider Directory

National Provider Directory

Locations

344 S Warren St
#610
Syracuse, NY 13202

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1124012018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 DOCKSIDE DR # 27",
            "city": "MORRISTOWN",
            "state": "NY",
            "postal_code": "136643231",
            "telephone_number": "315-482-2511",
            "fax_number": "315-482-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 FULLER ST",
            "city": "ALEXANDRIA BAY",
            "state": "NY",
            "postal_code": "136071316",
            "telephone_number": "315-482-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEAWAY RADIOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "GHARAGOZLOO",
        "authorized_official_first_name": "ALI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR OF GROUP",
        "authorized_official_telephone_number": "315-393-1215",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "198556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02728623",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria Bay, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.