NPIMap

Organization Active NPI

Integrated Telehealth Medicine PC

  • Psychiatry Physician
  • Oceanside, NY
National Provider Identifier
1124870233
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
INTEGRATED TELEHEALTH MEDICINE PC
Practice address
1 Healthy Way
Oceanside, NY 11572-1551
Phone
(855) 270-3625
NPI assigned
Apr 2, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Authorized official

Name
Cindy Walker
Title
Physician Services Director
Phone
(615) 418-1669

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

1 Healthy Way
Oceanside, NY 11572-1551

Mailing address

1501 42ND St Ste 575
West Des Moines, IA 50266-1060
Phone (855) 270-3625

Other names 1

  • Integrated Telehealth Medicine PC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241001001988 NY Part B Supplier - Clinic/Group Practice 7810428976 Receives reassigned benefits from 12 practitioners
Practice locations: Oceanside, NY

National Provider Directory

National Provider Directory

Locations

1501 42nd St
Ste 575
West Des Moines, IA 50266
Phone 8552703625171

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1124870233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 42ND ST STE 575",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661060",
            "telephone_number": "855-270-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HEALTHY WAY",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115721551",
            "telephone_number": "855-270-3625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED TELEHEALTH MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-02",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "PHYSICIAN SERVICES DIRECTOR",
        "authorized_official_telephone_number": "615-418-1669"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Telehealth Medicine PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Oceanside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.