Individual provider Active NPI

Alexandra Logan, MD

  • Internal Medicine Physician
  • Rochester, NY
National Provider Identifier
1205820008
Registry record updated Nov 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
251865 Issued in NY
Practice address
1425 Portland Ave
Rochester, NY 14621-3001
Phone
(585) 922-5067
Fax
(585) 922-2908
NPI assigned
Sep 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 251865 NY
Internal Medicine Physician 207R00000X 251865 NY Primary

Addresses

Primary practice location

1425 Portland Ave
Rochester, NY 14621-3001

Mailing address

1425 Portland Ave
Rochester, NY 14621-3001
Phone (585) 922-5067

Other identifiers 2

IdentifierTypeStateIssuer
03007063/NWKMedicaidNY
31696100MedicaidWI

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090406000364 NY Practitioner - Internal Medicine 6709975873 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
251865NYMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York Medical Physician Associates PC Hospitalist CurrentSince Jun 7, 2024 Accepting new patients
Westchester Medical Center Advanced Physician Services PC CurrentSince Aug 28, 2023 Accepting new patients
St Josephs Medical PC Internal Medicine CurrentSince Jul 14, 2018 Accepting new patients
North Medical PC Internal Medicine Current Accepting new patients
Westchester Medical Center Advanced Physician Services, PC CurrentSince Aug 28, 2023 Accepting new patients
New York Medical Physician Associates PC Internal Medicine CurrentSince Jun 7, 2024 Accepting new patients
Hospitalist Medicine Physicians of New York, PLLC Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

110 W 6th St
Oswego, NY 13126
Phone (315) 349-5511

241 North Rd
Poughkeepsie, NY 12601
Phone (845) 431-8889

255 Lafayette Ave
Suffern, NY 10901
Phone (845) 357-7830

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

95 Grasslands Rd
Valhalla, NY 10595
Phone (914) 493-2961

Organizations & group practices 7

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541980800000",
    "number": "1205820008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213001",
            "telephone_number": "585-922-5067",
            "fax_number": "585-922-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213001",
            "telephone_number": "585-922-5067",
            "fax_number": "585-922-2908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "ALEXANDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-07",
        "last_updated": "2018-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "251865",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "251865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03007063/NWK",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31696100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.