NPIMap

Individual provider Active NPI

Robert Charles Welliver Jr., MD

  • Urology Physician
  • Albany, NY
National Provider Identifier
1124287651
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
274981 Issued in NY
Practice address
23 Hackett Blvd
Albany, NY 12208-3436
Phone
(518) 262-3341
Fax
(518) 262-6660
NPI assigned
Jun 9, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 036-133090 IL
Urology Physician 208800000X 274981 NY Primary

Addresses

Primary practice location

23 Hackett Blvd
Albany, NY 12208-3436

Mailing address

711 Troy Schenectady Rd
Suite 203
Latham, NY 12110-2442
Phone (518) 782-3700

Other identifiers 2

IdentifierTypeStateIssuer
036133090MedicaidIL
03940636MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130826000041 IL Practitioner - Urology 7810130721 Reassigns benefits to 1 organization
I20140811001804 NY Practitioner - Urology 7810130721 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Albany Medical CollegeGroup PAC ID 1759293111, 1,054 clinicians

Practice addresses (Care Compare)

47 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-5633

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.78 of 100Reported as group
Quality
77.53
Promoting interoperability
100
Improvement activities
40
Cost
76.35

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-133090ILMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Medical College CurrentSince May 23, 2017 Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College CurrentSince Aug 1, 2020 Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Current Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Jul 15, 2013 Accepting new patients
Albany Medical College Current Accepting new patients
Columbia Memorial Hospital CurrentSince Mar 1, 2022 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Jul 15, 2013 Accepting new patients
Columbia Memorial Hospital CurrentSince Mar 1, 2022 Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College CurrentSince May 23, 2017 Accepting new patients
Community Care Physicians, PC Past Accepting new patients

Locations

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

23 Hackett Blvd
Albany, NY 12208
Phone (518) 262-3296

47 New Scotland Ave
#61
Albany, NY 12208
Phone (518) 262-5791

71 Prospect Ave
Hudson, NY 12534
Phone (518) 262-3773

1275 Broadway
Menands, NY 12204
Phone (518) 262-9705

2827 US Highway 9
Valatie, NY 12184
Phone (518) 828-7601

Interoperability endpoints

  • Direct secure messaging: rwelliver34072@albanymed.direct-ci.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420502400000",
    "number": "1124287651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD",
            "address_2": "SUITE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102442",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 HACKETT BLVD",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083436",
            "telephone_number": "518-262-3341",
            "fax_number": "518-262-6660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLIVER",
        "first_name": "ROBERT",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-09",
        "last_updated": "2015-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036-133090",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "274981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036133090",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03940636",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.