NPIMap

Organization Active NPI

Victor Internal Medicine & Pediatrics,P.C.

Doing business as Victor Health Associates

  • Internal Medicine Physician
  • Victor, NY
National Provider Identifier
1275673758
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
197675 Issued in NY
Legal business name
VICTOR INTERNAL MEDICINE & PEDIATRICS,P.C.
Doing business as
Victor Health Associates
Practice address
6532 Anthony Dr Ste a
Victor, NY 14564-1422
Phone
(585) 924-2100
Fax
(585) 398-1217
NPI assigned
Feb 7, 2007
Last updated
Mar 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Authorized official

Name
Kevin Dwain Penird, M.D.NPI 1265488803
Title
President
Phone
(585) 924-2158

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 197675 NY Primary
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

6532 Anthony Dr Ste a
Victor, NY 14564-1422

Mailing address

6532 Anthony Dr Ste a
Victor, NY 14564-1422
Phone (585) 924-2100

Other names 1

  • Victor Health Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080821000123 NY Part B Supplier - Clinic/Group Practice 9133294424 Receives reassigned benefits from 7 practitioners
Practice locations: Victor, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0172349Victor Internal Medicine & Pediatrics PC6532 Anthony Drive, Suite a, Victor, NY 14564Certificate of waiverApr 26, 2028

National Provider Directory

National Provider Directory

Locations

1331 E Victor Rd
Victor, NY 14564
Phone (585) 498-2280

6532 Anthony Dr
Ste A
Victor, NY 14564
Phone (585) 924-2100

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1275673758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6532 ANTHONY DR STE A",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145641422",
            "telephone_number": "585-924-2100",
            "fax_number": "585-398-1217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6532 ANTHONY DR STE A",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145641422",
            "telephone_number": "585-924-2100",
            "fax_number": "585-398-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTOR INTERNAL MEDICINE & PEDIATRICS,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "PENIRD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "DWAIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "585-924-2158",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "197675",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victor Health Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Victor Health Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victor, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.