NPIMap

Organization Active NPI

Adirondack Medical Center

Doing business as Adirondack Medical Center Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tupper Lake, NY
National Provider Identifier
1356656045
Registry record updated Oct 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
1623001H Issued in NY
Legal business name
ADIRONDACK MEDICAL CENTER
Doing business as
Adirondack Medical Center Dialysis
Practice address
114 Wawbeek Ave
Tupper Lake, NY 12986-2038
Phone
(518) 359-4900
Fax
(518) 891-5097
NPI assigned
Aug 18, 2010
Last updated
Oct 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2014

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

Authorized official

Name
Susan S Stratford, CPC
Title
PFS Supervisor
Phone
(518) 897-2636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 1623001H NY Primary

Addresses

Primary practice location

114 Wawbeek Ave
Tupper Lake, NY 12986-2038

Mailing address

114 Wawbeek Ave
Tupper Lake, NY 12986-2038
Phone (518) 359-4900

Other identifiers 1

IdentifierTypeStateIssuer
33-3564OtherNYMEDICARE CCN

Other names 1

  • Adirondack Medical Center Dialysis Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1282089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413417600000",
    "number": "1356656045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 WAWBEEK AVE",
            "city": "TUPPER LAKE",
            "state": "NY",
            "postal_code": "129862038",
            "telephone_number": "518-359-4900",
            "fax_number": "518-891-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 WAWBEEK AVE",
            "city": "TUPPER LAKE",
            "state": "NY",
            "postal_code": "129862038",
            "telephone_number": "518-359-4900",
            "fax_number": "518-891-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADIRONDACK MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-18",
        "last_updated": "2014-10-16",
        "status": "A",
        "authorized_official_last_name": "STRATFORD",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PFS SUPERVISOR",
        "authorized_official_telephone_number": "518-897-2636",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "1623001H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CCN",
            "identifier": "33-3564",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adirondack Medical Center Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tupper Lake, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.