Individual provider Active NPI

Dominick J Carillo, M.D.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Glens Falls, NY
National Provider Identifier
1336214469
Registry record updated May 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
189110 Issued in NY
Practice address
100 Park St
Glens Falls Hospital
Glens Falls, NY 12801-4413
Phone
(518) 926-3000
Fax
(518) 926-3127
NPI assigned
Nov 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 189110 NY Primary

Addresses

Primary practice location

100 Park St
Glens Falls Hospital
Glens Falls, NY 12801-4413

Mailing address

100 Park St
Glens Falls Hospital - Credentialing
Glens Falls, NY 12801-4413
Phone (518) 926-5100

Other identifiers 1

IdentifierTypeStateIssuer
70021AOtherMEDICARE PART B

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
I20080611000099 NY Practitioner - Emergency Medicine 8729066170 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.78 of 100Reported as group
Quality
77.53
Promoting interoperability
100
Improvement activities
40
Cost
76.35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
189110NYMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Medical College Current Accepting new patients
Emergency Care Services of New York, P.C. CurrentSince Oct 1, 2017 Accepting new patients
Albany Medical College CurrentSince Jul 1, 2021 Accepting new patients
Albany Medical College CurrentSince Jul 1, 2021 Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College CurrentSince Jul 1, 2021 Accepting new patients

Locations

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

100 Park St
Glens Falls, NY 12801
Phone (518) 926-5924

321 Genesee St
Oneida, NY 13421
Phone (315) 361-2020

211 Church St
Saratoga Springs, NY 12866
Phone (518) 583-8461

Interoperability endpoints

  • Direct secure messaging: dcarillo23096@albanymed.direct-ci.com

Organizations & group practices 6

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": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493942400000",
    "number": "1336214469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PARK ST",
            "address_2": "GLENS FALLS HOSPITAL - CREDENTIALING",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128014413",
            "telephone_number": "518-926-5100",
            "fax_number": "518-926-6983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PARK ST",
            "address_2": "GLENS FALLS HOSPITAL",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128014413",
            "telephone_number": "518-926-3000",
            "fax_number": "518-926-3127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARILLO",
        "first_name": "DOMINICK",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2017-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "NY",
            "license": "189110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART  B",
            "identifier": "70021A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glens Falls, NY

Sources for this page

Verify at the official NPI Registry.