Individual provider Active NPI

Robert Michael Song, MD

  • Emergency Medicine Physician
  • Bronx, NY
National Provider Identifier
1174902514
Registry record updated Nov 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
298012 Issued in NY
Practice address
1400 Pelham Pkwy S BLDG 6
Bronx, NY 10461-1119
Phone
(718) 918-5820
NPI assigned
May 19, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 298012 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1400 Pelham Pkwy S BLDG 6
Bronx, NY 10461-1119

Mailing address

18 N Broadway Unit 107
Tarrytown, NY 10591-3223
Phone (631) 901-8675

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190605002462 NY Practitioner - Emergency Medicine 2163755125 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
298012NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dobbs Ferry Emergency Medicine, PC Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients
Jacobi Medical Center Ed Past Accepting new patients

Locations

128 Ashford Ave
Dobbs Ferry, NY 10522
Phone (914) 245-8936

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1174902514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 N BROADWAY UNIT 107",
            "city": "TARRYTOWN",
            "state": "NY",
            "postal_code": "105913223",
            "telephone_number": "631-901-8675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PELHAM PKWY S BLDG 6",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611119",
            "telephone_number": "718-918-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "ROBERT",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-19",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "298012",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.