Active NPI
American Comprehensive Healthcare Medical Group
- Obstetrics & Gynecology Physician
- Brooklyn, NY
National Provider Identifier
1174928378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 002201
- Legal business name
- AMERICAN COMPREHENSIVE HEALTHCARE MEDICAL GROUP
- Practice address
- 5205-7 Church Avenue
Brooklyn, NY 11203-3513 - Phone
- (718) 688-8088
- Fax
- (718) 688-8018
- NPI assigned
- Oct 30, 2014
- Last updated
- Oct 30, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kelvin K Jack, M.D.
- Title
- President
- Phone
- (718) 688-8088
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 002201 | NY | Primary |
Addresses
Primary practice location
5205-7 Church Avenue
Brooklyn, NY 11203-3513
Mailing address
5205-7 Church Avenue
Brooklyn, NY 11203-0386
Phone (718) 688-8088
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002778018 | Medicaid | NY | |
| 002201 | Other | NY | LICENSE |
National Provider Directory
National Provider Directory- Tax ID family
- American Comprehensive Healthcare Medical Group
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Specialist
- Brooklyn, NY
- NPI 1316289853
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414627200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1414627200000",
"number": "1174928378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5205-7 CHURCH AVENUE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112030386",
"telephone_number": "718-688-8088",
"fax_number": "718-688-8081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5205-7 CHURCH AVENUE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112033513",
"telephone_number": "718-688-8088",
"fax_number": "718-688-8018"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AMERICAN COMPREHENSIVE HEALTHCARE MEDICAL GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2014-10-30",
"last_updated": "2014-10-30",
"status": "A",
"authorized_official_last_name": "JACK",
"authorized_official_first_name": "KELVIN",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "718-688-8088",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": "NY",
"license": "002201",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002778018",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "002201",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
- American Biomed Homecare
- American Biomed Instrument Inc
- American Chiropractic Center
- American Chiropractic Office of Manhattan, P.C.
- American Chore Services (City Choice Home Care Services)
- American Comprehensive Healthcare Medical Group PC
- American Comprehensive Healthcare Medical Group. PC
- American Express Limo Inc.
- American Faiye
- American Health and Survival Resources Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.