Individual provider Active NPI

Peter R Maggiore, MD

  • Internal Medicine Physician
  • Troy, NY
National Provider Identifier
1356343206
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
168264 Issued in NY
Practice address
1401 Massachusetts Ave
Troy, NY 12180
Phone
(518) 268-5242
Fax
(518) 268-5480
NPI assigned
Aug 11, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 168264 NY
Internal Medicine Physician 207R00000X 168264 NY Primary

Addresses

Primary practice location

1401 Massachusetts Ave
Troy, NY 12180

Mailing address

PO Box 14890
Albany, NY 12212-4890
Phone (518) 525-5634

Other practice location 1

1202 Medical Center Dr
Wilmington, NC 28401-7307
Phone (910) 341-3300

Other identifiers 1

IdentifierTypeStateIssuer
01087690MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

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
I20071207000367 NY Practitioner - Internal MedicinePractitioner - Infectious Disease 5890784995 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Peter R Maggiore MD PC Infectious Disease CurrentSince Oct 3, 2007 Accepting new patients
Samaritan Hospital of Troy, New York Internal Medicine CurrentSince Jan 1, 2019 Accepting new patients

Locations

317 S Manning Blvd
Ste 250
Albany, NY 12208
Phone (518) 446-1162

713 Troy Schenectady Rd
Ste 304
Latham, NY 12110
Phone (518) 373-4448

147 Hoosick St
Troy, NY 12180
Phone (518) 268-5749

1401 Massachusetts Ave
Troy, NY 12180
Phone (518) 268-5242

2215 Burdett Ave
Troy, NY 12180
Phone (518) 271-3300

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1356343206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "518-525-5634",
            "fax_number": "518-649-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MASSACHUSETTS AVE",
            "city": "TROY",
            "state": "NY",
            "postal_code": "12180",
            "telephone_number": "518-268-5242",
            "fax_number": "518-268-5480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1202 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284017307",
            "country_code": "US",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-8824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAGGIORE",
        "first_name": "PETER",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NY",
            "license": "168264",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "168264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01087690",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPH Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1401 Massachusetts Ave",
            "city": "Troy",
            "state": "NY",
            "country_code": "US",
            "postal_code": "12180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Troy, NY

Sources for this page

Verify at the official NPI Registry.