Organization Active NPI

Lutheran Medical Care PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Brooklyn, NY
National Provider Identifier
1134410780
Registry record updated Apr 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
Legal business name
LUTHERAN MEDICAL CARE PLLC
Practice address
8201 4TH Ave Apt 1D
Brooklyn, NY 11209-4429
Phone
(718) 630-5409
Fax
(718) 748-5467
NPI assigned
Apr 29, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2011

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

Authorized official

Name
Dr. Eugene Gibilaro, M.D.NPI 1043267610
Title
President
Phone
(718) 630-5409

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X Primary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X

Addresses

Primary practice location

8201 4TH Ave Apt 1D
Brooklyn, NY 11209-4429

Mailing address

8201 4TH Ave Apt 1D
Brooklyn, NY 11209-4429
Phone (718) 630-5409

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111108000907 NY Part B Supplier - Clinic/Group Practice 0547433443 Receives reassigned benefits from 2 practitioners
Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

623 Bay Ridge Pkwy
#1
Brooklyn, NY 11209
Phone (718) 833-7535

Practitioners & affiliated clinicians

Practitioners 4

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": "1304035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304035200000",
    "number": "1134410780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8201 4TH AVE APT 1D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112094429",
            "telephone_number": "718-630-5409",
            "fax_number": "718-748-5467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 4TH AVE APT 1D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112094429",
            "telephone_number": "718-630-5409",
            "fax_number": "718-748-5467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN MEDICAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-29",
        "last_updated": "2011-04-29",
        "status": "A",
        "authorized_official_last_name": "GIBILARO",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-630-5409",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; 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.