Active NPI
South Elliot South Portland Medical Comprehensive Medical Center
- Family Medicine Physician
- Brooklyn, NY
National Provider Identifier
1184844870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 147143
- Legal business name
- SOUTH ELLIOT SOUTH PORTLAND MEDICAL COMPREHENSIVE MEDICAL CENTER
- Practice address
- 739 Fulton St
Brooklyn, NY 11217-1560 - Phone
- (718) 858-5088
- Fax
- (718) 858-5278
- NPI assigned
- Apr 26, 2007
- 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
- Dr. Camille Philippe, MD, PC
- Title
- Medical Director
- Phone
- (718) 858-5088
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 147143 | NY | Primary |
Addresses
Primary practice location
739 Fulton St
Brooklyn, NY 11217-1560
Mailing address
Gpo 27007
New York, NY 10087-7007
Phone (718) 858-5088
Other identifiers 16
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0102306 | Other | NY | UNITED HEALTHCARE |
| 209917 | Other | NY | WELLCARE |
| 5C4093 | Other | NY | HEALTHNET |
| 5038C1 | Other | NY | EMPIRE BCBS |
| 00924438 | Medicaid | NY | |
| 50013 | Other | NY | VYTRA |
| 10201320 | Other | NY | AMERIGROUP |
| 147143 | Other | NY | HIP |
| 650251 | Other | NY | CIGNA |
| BKX033703 | Other | NY | AMERICHOICE |
| P2664504 | Other | NY | OXFORD |
| 72468 | Other | NY | GHI-HMO |
| 5998068 | Other | NY | GHI |
| 147143C17 | Other | NY | HEALTHFIRST |
| 170899 | Other | NY | ELDERPLAN |
| 2835366 | Other | NY | AETNA |
Other names 1
- Camille Philippe
National Provider Directory
National Provider DirectoryLocations
Gpo 27007
New York, NY 10087
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1210896000000",
"number": "1184844870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "GPO 27007",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100877007",
"telephone_number": "718-858-5088",
"fax_number": "718-858-5278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "739 FULTON ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112171560",
"telephone_number": "718-858-5088",
"fax_number": "718-858-5278"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTH ELLIOT SOUTH PORTLAND MEDICAL COMPREHENSIVE MEDICAL CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-26",
"last_updated": "2008-05-16",
"status": "A",
"authorized_official_last_name": "PHILIPPE",
"authorized_official_first_name": "CAMILLE",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "718-858-5088",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD, PC"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "NY",
"license": "147143",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0102306",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "209917",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "5C4093",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BCBS",
"identifier": "5038C1",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00924438",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VYTRA",
"identifier": "50013",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "10201320",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "147143",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "650251",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "BKX033703",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P2664504",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI-HMO",
"identifier": "72468",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "5998068",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHFIRST",
"identifier": "147143C17",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ELDERPLAN",
"identifier": "170899",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2835366",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Camille Philippe",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Brooklyn, NY
- South Brooklyn Nephrology Center Inc
- South Brooklyn Nephrology Center Inc
- South Brooklyn Pharma Corp
- South Brooklyn Psychological Services PLLC
- South Brooklyn Radiology PLLC
- South Shore Manor Home for Adults
- South Shore Osteopathic Medicine P.C.
- South Side Drugs Inc
- South Side Pharmacy & Health Shop LLC
- South Side Pharmacy & Health Shop LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.