Individual provider Active NPI

Lucinda Grovenburg, MD

  • Addiction Medicine (Family Medicine) Physician
  • Kerhonkson, NY
National Provider Identifier
1275691180
Registry record updated Nov 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
License
188450 Issued in NY
Practice address
5 Golden LN
Kerhonkson, NY 12446-1609
Phone
(845) 626-3424
Fax
(845) 626-4627
NPI assigned
Dec 4, 2006
Last updated
Nov 2, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) Physician 207QA0401X 188450 NY Primary

Addresses

Primary practice location

5 Golden LN
Kerhonkson, NY 12446-1609

Mailing address

5 Golden LN
Kerhonkson, NY 12446-1609
Phone (845) 626-3424

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
I20040303000714 NY Practitioner - Family PracticePractitioner - Addiction Medicine 8325935372 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Addiction Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tabasco Family Practice PLLCGroup PAC ID 9234111345, 2 clinicians

Practice addresses (Care Compare)

5 Golden LN
Kerhonkson, NY 12446-1609
Phone (845) 626-3424

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
188450NYMDAddiction Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tabasco Family Practice PLLC Addiction Medicine CurrentSince Jan 23, 2003 Accepting new patients
Mid-Hudson Family Health Institute 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.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193961600000",
    "number": "1275691180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 GOLDEN LN",
            "city": "KERHONKSON",
            "state": "NY",
            "postal_code": "124461609",
            "telephone_number": "845-626-3424",
            "fax_number": "845-626-4627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GOLDEN LN",
            "city": "KERHONKSON",
            "state": "NY",
            "postal_code": "124461609",
            "telephone_number": "845-626-3424",
            "fax_number": "845-626-4627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROVENBURG",
        "first_name": "LUCINDA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NY",
            "license": "188450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kerhonkson, NY

Sources for this page

Verify at the official NPI Registry.