Individual provider Active NPI

Jill Braverman-Panza, MD

  • Internal Medicine Physician
  • Albany, NY
National Provider Identifier
1366458895
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
1636810 Issued in NY
Practice address
1375 Washington Ave
Suite 202
Albany, NY 12206
Phone
(518) 482-0007
Fax
(518) 482-0008
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1636810 NY Primary

Addresses

Primary practice location

1375 Washington Ave
Suite 202
Albany, NY 12206

Mailing address

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

Other practice location 1

1 Tallow Wood Dr
Clifton Park, NY 12065-2807
Phone (518) 451-7530

Other practice location 2

1735 Route 9
Halfmoon, NY 12065-2421
Phone (518) 901-1619

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
I20080403000058 NY Practitioner - Internal Medicine 8123095262 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Albany Medical College of Union University, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 Tallow Wood Dr
Clifton Park, NY 12065-2807
Phone (518) 373-4444

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1636810NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Hospital of Troy, New York Internal Medicine CurrentSince Feb 1, 2024 Accepting new patients
St. Peter'S Health Partners Medical Associates, P.C. Internal Medicine CurrentSince Aug 19, 2013 Accepting new patients
Jill Braverman-Panza MD Internal Medicine PastSince Jan 1, 1990 Accepting new patients

Locations

1 Tallow Wood Dr
Clifton Park, NY 12065
Phone (518) 373-4444

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

Interoperability endpoints

  • Direct secure messaging: jbravermanpanza858442@direct.trinity-health.org

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1366458895",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 WASHINGTON AVE",
            "address_2": "SUITE 202",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "12206",
            "telephone_number": "518-482-0007",
            "fax_number": "518-482-0008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Tallow Wood Dr",
            "address_purpose": "LOCATION",
            "city": "Clifton Park",
            "state": "NY",
            "postal_code": "120652807",
            "country_code": "US",
            "telephone_number": "518-451-7530",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1735 Route 9",
            "address_purpose": "LOCATION",
            "city": "Halfmoon",
            "state": "NY",
            "postal_code": "120652421",
            "country_code": "US",
            "telephone_number": "518-901-1619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRAVERMAN-PANZA",
        "first_name": "JILL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "1636810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP- Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1375 Washington Ave",
            "address_2": "Suite 202",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "12206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.