NPIMap

Organization Active NPI

Samaritan Daytop Village, Inc.

  • Multi-Specialty Clinic/Center
  • Bronx, NY
National Provider Identifier
1154795235
Registry record updated Apr 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SAMARITAN DAYTOP VILLAGE, INC.
Practice address
250 Grand Concourse
Bronx, NY 10451-5430
Phone
(718) 292-2240
NPI assigned
Nov 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2016

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

Authorized official

Name
Mr. Charles Madray, MBA
Title
Vice President of Health Services &
Phone
(718) 206-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

250 Grand Concourse
Bronx, NY 10451-5430

Mailing address

13802 Queens Blvd
Briarwood, NY 11435-2642

Other identifiers 1

IdentifierTypeStateIssuer
000245309MedicaidNY

Other names 1

  • Samaritan Village Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161004000379 NY Part B Supplier - Clinic/Group Practice 8123242906 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bronx, NY

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Samaritan Village21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Practitioners & affiliated clinicians

Practitioners 2

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": "1448841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460678400000",
    "number": "1154795235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13802 QUEENS BLVD",
            "city": "BRIARWOOD",
            "state": "NY",
            "postal_code": "114352642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515430",
            "telephone_number": "718-292-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN DAYTOP VILLAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-30",
        "last_updated": "2016-04-15",
        "status": "A",
        "authorized_official_last_name": "MADRAY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "VICE PRESIDENT OF HEALTH SERVICES &",
        "authorized_official_telephone_number": "718-206-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000245309",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Village Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; 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.