NPIMap

Organization Active NPI

Comprehensive Family Medical Practice, PC

  • Family Medicine Physician
  • Bayside, NY
National Provider Identifier
1194023135
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMPREHENSIVE FAMILY MEDICAL PRACTICE, PC
Practice address
21008 35TH Ave
Bayside, NY 11361-1431
Phone
(718) 229-4090
Fax
(866) 457-6793
NPI assigned
Feb 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Authorized official

Name
Jia Park, MDNPI 1588774921
Title
Owner
Phone
(718) 229-4090

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

21008 35TH Ave
Bayside, NY 11361-1431

Mailing address

21008 35TH Ave
Bayside, NY 11361-1431
Phone (718) 229-4090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110826000219 NY Part B Supplier - Clinic/Group Practice 9032389275 Receives reassigned benefits from 1 practitioner
Practice locations: Bayside, NY

National Provider Directory

National Provider Directory

Locations

21008 35th Ave
Bayside, NY 11361
Phone (718) 229-4090

Practitioners & affiliated clinicians

Practitioners 2

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": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1194023135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21008 35TH AVE",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113611431",
            "telephone_number": "718-229-4090",
            "fax_number": "866-457-6793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21008 35TH AVE",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113611431",
            "telephone_number": "718-229-4090",
            "fax_number": "866-457-6793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE FAMILY MEDICAL PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-28",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-229-4090",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; 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.