NPIMap

Individual provider Active NPI

Todd M Podkowka, D.O.

  • Family Medicine Physician
  • Boonville, NY
National Provider Identifier
1174633622
Registry record updated Mar 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
216019 Issued in NY
Practice address
6483 Cone Rd
Boonville, NY 13309-3311
Phone
(315) 339-6536
Fax
(315) 339-8089
NPI assigned
Aug 30, 2006
Last updated
Mar 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 216019 NY Primary

Addresses

Primary practice location

6483 Cone Rd
Boonville, NY 13309-3311

Mailing address

6483 Cone Rd
Boonville, NY 13309-3311
Phone (315) 339-6536

Other identifiers 1

IdentifierTypeStateIssuer
06000216019MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040629000736 NY Practitioner - Family Practice 4789660739 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

101 S St
Morrisville, NY 13408-2106
Phone (315) 684-5117

6483 Cone Rd
Boonville, NY 13309-3311
Phone (315) 571-8054

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
State of New York Comptrollers Office CurrentSince Jun 1, 2019 Accepting new patients
MVHS Inc CurrentSince Jun 18, 2018 Accepting new patients
Crouse-Community Center, Inc CurrentSince Jan 2, 2016 Accepting new patients
Todd M Podkowka DO PLLC Family Medicine CurrentSince Oct 10, 2012 Accepting new patients
State of New York Comptrollers Office CurrentSince Jun 1, 2019 Accepting new patients
MVHS Inc Family Medicine CurrentSince Jun 18, 2018 Accepting new patients
Rome Memorial Hospital, Inc. Past Accepting new patients
Rome Memorial Hospital, Inc. Past Accepting new patients
State of New York Past Accepting new patients

Locations

44 Holland Ave
Fl 4
Albany, NY 12208

305 Main St
Binghamton, NY 13905
Phone (607) 729-1295

13460 State Route 12
Boonville, NY 13309
Phone (315) 942-4391

101 South St
Morrisville, NY 13408
Phone (315) 684-9595

1617 N James St
Ste 500
Rome, NY 13440
Phone (315) 336-3380

120 Hobart St
Utica, NY 13501
Phone (315) 798-1149

1676 Sunset Ave
Utica, NY 13502
Phone (315) 624-5567

2150 Bleecker St
Utica, NY 13501
Phone (315) 798-4800

2209 Genesee St
Utica, NY 13501
Phone (315) 798-8100

Interoperability endpoints

  • Direct secure messaging: performance_physical_therapy@hiemail.healtheconnections.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583452800000",
    "number": "1174633622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6483 CONE RD",
            "city": "BOONVILLE",
            "state": "NY",
            "postal_code": "133093311",
            "telephone_number": "315-339-6536",
            "fax_number": "315-339-8089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6483 CONE RD",
            "city": "BOONVILLE",
            "state": "NY",
            "postal_code": "133093311",
            "telephone_number": "315-339-6536",
            "fax_number": "315-339-8089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PODKOWKA",
        "first_name": "TODD",
        "middle_name": "M",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "216019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06000216019",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boonville, NY

Sources for this page

Verify at the official NPI Registry.