Active NPI
Carl Boris, D.O.
- Family Medicine Physician
- Massapequa, NY
National Provider Identifier
1194883793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 089458
- Practice address
- 99 Grand Ave
Massapequa, NY 11758-1203 - Phone
- (516) 541-9700
- Fax
- (516) 798-1086
- NPI assigned
- Dec 5, 2006
- Last updated
- May 19, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 089458 | NY | Primary |
Addresses
Primary practice location
99 Grand Ave
Massapequa, NY 11758-1203
Mailing address
99 Grand Ave
Massapequa, NY 11758-1203
Phone (516) 795-2626
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00404884 | Medicaid | NY | |
| 201285536 | Other | UNITED HEALTHCARE | |
| AP624 | Other | OXFORD | |
| 5491B1 | Other | BLUE CROSS BLUE SHIELD | |
| 785722 | Other | CIGNA | |
| 089458 | Other | HIP | |
| 201285536 | Other | EMPIRE | |
| 4115108 | Other | AETNA | |
| 5996232 | Other | GHI | |
| 201285536 | Other | MAGNACARE | |
| 5061 | Other | VYTRA | |
| 5C4402 | Other | HEALTH NET | |
| P00230863 | Other | RR MCR |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151027003170 | NY | Order and Referring Only - Family Practice | 1557392420 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 089458 | NY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CHS Physician Partners, P.C | Past | Accepting new patients | |
| Long Island Primary Medical Care | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1194883793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 GRAND AVE",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "117581203",
"telephone_number": "516-795-2626",
"fax_number": "516-799-7451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 GRAND AVE",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "117581203",
"telephone_number": "516-541-9700",
"fax_number": "516-798-1086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORIS",
"first_name": "CARL",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-05",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "089458",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00404884",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "201285536",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "AP624",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "5491B1",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "785722",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "089458",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE",
"identifier": "201285536",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4115108",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "5996232",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGNACARE",
"identifier": "201285536",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VYTRA",
"identifier": "5061",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "5C4402",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MCR",
"identifier": "P00230863",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Massapequa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.