Active NPI
John M. Supple, M.D
- Family Medicine Physician
- Millbrook, NY
National Provider Identifier
1356596266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 098946
- Practice address
- 3573 RT. 82
Millbrook, NY 12545 - Phone
- (845) 677-0547
- Fax
- (845) 677-0547
- NPI assigned
- Nov 19, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 098946 | NY | Primary |
Addresses
Primary practice location
3573 RT. 82
Millbrook, NY 12545
Mailing address
3573 RT. 82
Millbrook, NY 12545
Phone (845) 677-0547
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 098946 | NY | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227052800000",
"number": "1356596266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3573 RT. 82",
"city": "MILLBROOK",
"state": "NY",
"postal_code": "12545",
"telephone_number": "845-677-0547",
"fax_number": "845-677-0547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3573 RT. 82",
"city": "MILLBROOK",
"state": "NY",
"postal_code": "12545",
"telephone_number": "845-677-0547",
"fax_number": "845-677-0547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPPLE",
"first_name": "JOHN",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-19",
"last_updated": "2008-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "098946",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Millbrook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.