Active NPI
Carlos Alberto Concepcion, PA-C
- Physician Assistant
- Bay Shore, NY
National Provider Identifier
1194976787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 004769
- Practice address
- 1377 5TH Ave
Bay Shore, NY 11706-4131 - Phone
- (631) 647-3265
- NPI assigned
- Oct 1, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004769 | NY | Primary |
Addresses
Primary practice location
1377 5TH Ave
Bay Shore, NY 11706-4131
Mailing address
111 Cliff Rd
Port Jefferson, NY 11777-1252
Phone (631) 235-4185
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004769 | NY | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jay B Stambler MD Medical PC | Current | Accepting new patients | |
| Anne Arundel Medical Center Pharmacy | Past | Accepting new patients |
Locations
178 W Main St
Patchogue, NY 11772
Phone (631) 438-0333
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- Westbury, NY
- NPI 1881863447
-
- Internal Medicine Physician
- Patchogue, NY
- NPI 1841776952
-
- Community/Retail Pharmacy
- Annapolis, MD
- NPI 1861720526
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438732800000",
"number": "1194976787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 CLIFF RD",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771252",
"telephone_number": "631-235-4185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1377 5TH AVE",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117064131",
"telephone_number": "631-647-3265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONCEPCION",
"first_name": "CARLOS",
"middle_name": "ALBERTO",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-01",
"last_updated": "2015-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "004769",
"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 Aug 5, 2015; 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.