NPIMap

Organization Active NPI

St. Peter'S Health Partners Medical Associates, P.C.

  • Internal Medicine Physician
  • Albany, NY
National Provider Identifier
1356686331
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.
Practice address
1375 Washington Ave Ste 202
St. Peter'S Internal Medicine
Albany, NY 12206-1056
Phone
(518) 482-0007
NPI assigned
Dec 3, 2012
Organization subpart
Yes
Parent organization
ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Authorized official

Name
Courtney Knowles
Title
Credentialing Manager
Phone
(518) 525-5634

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary
Multi-Specialty Clinic/Center 261QM1300X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1375 Washington Ave Ste 202
St. Peter'S Internal Medicine
Albany, NY 12206-1056

Mailing address

PO Box 14890
Albany, NY 12212-4890

Other identifiers 1

IdentifierTypeStateIssuer
03539695MedicaidNY

Other names 2

  • Braverman-Panza Internal Medicine Other name
  • St. Peter's Internal Medicine Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct St. Peter's Health Partners Medical Associates, P.C.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130321000567 NY Part B Supplier - Clinic/Group Practice 6103061189 Receives reassigned benefits from 869 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
St Peter'S Health Partners Medical Associates PC

NPI Registry JSON

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

{
    "created_epoch": "1354492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1356686331",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 WASHINGTON AVE STE 202",
            "address_2": "ST. PETER'S INTERNAL MEDICINE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122061056",
            "telephone_number": "518-482-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.",
        "enumeration_date": "2012-12-03",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-23",
        "status": "A",
        "authorized_official_last_name": "KNOWLES",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "518-525-5634"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03539695",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "Y",
            "endpointDescription": "SPHP Payer Credentialing",
            "affiliationName": "St. Peter's Health Partners Medical Associates, P.C.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1375 Washington Ave Ste 202",
            "address_2": "St. Peter's Internal Medicine",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122061056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Braverman-Panza Internal Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Braverman-Panza Internal Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "St. Peter's Internal Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.