NPIMap

Organization Active NPI

Li Medical Group PLLC

  • Internal Medicine Physician
  • New Hyde Park, NY
National Provider Identifier
1144878414
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LI MEDICAL GROUP PLLC
Practice address
2090 Jericho Tpke
New Hyde Park, NY 11040-4719
Phone
(516) 352-7828
NPI assigned
Aug 29, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Authorized official

Name
Luke Walton
Title
Enrollment Manager
Phone
(951) 900-3156

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2090 Jericho Tpke
New Hyde Park, NY 11040-4719

Mailing address

2090 Jericho Tpke
New Hyde Park, NY 11040-4719

Other identifiers 1

IdentifierTypeStateIssuer
01439550MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221215002053 NY Part B Supplier - Clinic/Group Practice 7517397045 Receives reassigned benefits from 8 practitioners
Practice locations: New Hyde Park, NY

National Provider Directory

National Provider Directory

Locations

2090 Jericho Tpke
Ofc 1
New Hyde Park, NY 11040

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1567036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1144878414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 JERICHO TPKE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110404719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 JERICHO TPKE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110404719",
            "telephone_number": "516-352-7828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LI MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-29",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "951-900-3156"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01439550",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hyde Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.