NPIMap

Organization Active NPI

Premiere Cardiology PLLC

  • Cardiovascular Disease Physician
  • Bay Shore, NY
National Provider Identifier
1184858151
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
200075 Issued in NY
Legal business name
PREMIERE CARDIOLOGY PLLC
Practice address
1916 Union Blvd
Bay Shore, NY 11706-7921
Phone
(631) 666-2291
Fax
(631) 666-2283
NPI assigned
May 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Dr. Laura Coudrey, MD
Title
President
Phone
(631) 666-2290

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X 200075 NY Primary

Addresses

Primary practice location

1916 Union Blvd
Bay Shore, NY 11706-7921

Mailing address

1916 Union Blvd
Bay Shore, NY 11706-7921
Phone (631) 666-2291

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090730000423 NY Part B Supplier - Clinic/Group Practice 0446303911 Receives reassigned benefits from 11 practitioners
Practice locations: Bay Shore, NY

National Provider Directory

National Provider Directory

Locations

1916 Union Blvd
Bay Shore, NY 11706
Phone (631) 666-2290

Practitioners & affiliated clinicians

Practitioners 11

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": "1241568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1184858151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 UNION BLVD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067921",
            "telephone_number": "631-666-2291",
            "fax_number": "631-666-2283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 UNION BLVD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067921",
            "telephone_number": "631-666-2291",
            "fax_number": "631-666-2283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERE CARDIOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-06",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "COUDREY",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-666-2290",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "200075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.