St Lawrence Radiology Assoc PC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

ST LAWRENCE RADIOLOGY ASSOC PC

Practice address

50 Leroy St
Canton Potsdam Hospital
Potsdam, NY 13676-1786

Phone

(315) 782-2620

Fax

(315) 788-4980

NPI assigned

Mar 21, 2006

Last updated

Jun 1, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Glauco Maresca, MDNPI 1053370742

Title

President/Ceo

Phone

(315) 265-4924

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY, WA, CA, PA, MA, AZ, CO, OH, FL, KY, IL, OK, VA, NH14 enrollments

Enrollment records 14

Locations

Practitioners 65

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.

• Glauco Michael Maresca, MD

  • Diagnostic Radiology Physician
  • Potsdam, NY
  • NPI 1053370742
  Medicare reassignment Care Compare group NPD Authorized official
• Jeffrey J Buran, MD

  • Diagnostic Radiology Physician
  • Plattsburgh, NY
  • NPI 1598723652
  Medicare reassignment Care Compare group NPD
• Kirwin Gregory Gibbs, MD

  • Therapeutic Radiology Physician
  • Cortland, NY
  • NPI 1043279748
  Medicare reassignment Care Compare group NPD
• Jubin Jacob, MD

  • Diagnostic Radiology Physician
  • Potsdam, NY
  • NPI 1710305115
  Medicare reassignment Care Compare group NPD
• Mark Kwalbrun, MD

  • Diagnostic Radiology Physician
  • Watertown, NY
  • NPI 1811997042
  Medicare reassignment Care Compare group NPD
• Andrew Lewis, M.D.

  • Specialist
  • Ossining, NY
  • NPI 1528024817

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• Mordechai Rehany, MD

  • Vascular & Interventional Radiology Physician
  • Malone, NY
  • NPI 1427017912

  Diagnostic Radiology

  Medicare reassignment Care Compare group NPD
• Terence Duran Schumpert, MD

  • Diagnostic Radiology Physician
  • Massena, NY
  • NPI 1043279730
  Medicare reassignment Care Compare group NPD
• Salil Sharma, M.D

  • Diagnostic Radiology Physician
  • Cooperstown, NY
  • NPI 1437415056
  Medicare reassignment Care Compare group NPD
• Neal Hong Young, MD

  • Vascular & Interventional Radiology Physician
  • Warsaw, NY
  • NPI 1144420241

  Diagnostic Radiology, VA

  Medicare reassignment Care Compare group NPD
• Gregory Hapet Berberian, M.D.

  • Diagnostic Radiology Physician
  • Worcester, MA
  • NPI 1457662520
  Medicare reassignment Care Compare group NPD
• Maximina Boutselis, M.D.

  • Diagnostic Radiology Physician
  • West Newbury, MA
  • NPI 1013946094

  NY

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1154380863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41643",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212036643",
            "telephone_number": "443-274-2888",
            "fax_number": "443-274-2391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 LEROY ST",
            "address_2": "CANTON POTSDAM HOSPITAL",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761786",
            "telephone_number": "315-782-2620",
            "fax_number": "315-788-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LAWRENCE RADIOLOGY ASSOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "MARESCA",
        "authorized_official_first_name": "GLAUCO",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "315-265-4924",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01350563",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cherish Spencer, MSN, CNM
• Jennie Spooner
• Kim L. Sprague, RPH
• Mallory Sprague, MD
• St Lawerence Oral and Maxilliofacial Surgery
• St. Lawrence Cardiology
• St. Lawrence Oral and Maxillofacial Surgery Associates PC
• St. Lawrence Orthopedics Specialists PC
• Amy St.Hilaire, RN
• Bethany L St.Hilaire

• Diagnostic Radiology Physician in Potsdam, NY
• Providers in Potsdam, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 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.