NPIMap

Organization Active NPI

Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Liverpool, NY
National Provider Identifier
1366498768
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
CONIFER PARK, INC.
Practice address
526 Old Liverpool Rd
Liverpool, NY 13088-6238
Phone
(315) 453-3911
Fax
(315) 453-0197
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Authorized official

Name
Ms. Tammy Smith
Title
Director, Op Billing Dept
Phone
(518) 952-8408

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

526 Old Liverpool Rd
Liverpool, NY 13088-6238

Mailing address

PO Box 10092
Albany, NY 12201-5092
Phone (518) 952-8408

Other identifiers 1

IdentifierTypeStateIssuer
01420800MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040503001584 NY Part B Supplier - Clinic/Group Practice 2769470384 Receives reassigned benefits from 20 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Troy, NY; Schenectady, NY; Rochester, NY; Liverpool, NY; Glenville, NY; Glens Falls, NY; Plattsburgh, NY
O20200819001466 NY Part B Supplier - Opioid Treatment Program (Otp) 2769470384 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Liverpool, NY; Troy, NY; Plattsburgh, NY; Schenectady, NY

Other NPIs on the same Medicare enrollment 8

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2028444Conifer Park - Liverpool Opc526 Old Liverpool Rd - Suite 4, Liverpool, NY 13088Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Conifer Park Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

55 Elm St
Glens Falls, NY 12801
Phone (518) 793-7273

216 Main St
Ste 2
Hudson Falls, NY 12839
Phone (518) 747-0266

1051 Dix Ave
#E
Hudson Falls, NY 12839
Phone (518) 746-3500

80 Sharron Ave
Plattsburgh, NY 12901
Phone (518) 561-1447

15 Henning Rd
#F
Saratoga Springs, NY 12866
Phone (518) 581-3600

600 Franklin St
Ste 204
Schenectady, NY 12305
Phone (518) 372-7031

1801 6th Ave
Troy, NY 12180
Phone (518) 271-1122

Practitioners & affiliated clinicians

Practitioners 195

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 195

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619654400000",
    "number": "1366498768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10092",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122015092",
            "telephone_number": "518-952-8408",
            "fax_number": "518-399-6860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 OLD LIVERPOOL RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130886238",
            "telephone_number": "315-453-3911",
            "fax_number": "315-453-0197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONIFER PARK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "DIRECTOR, OP BILLING DEPT",
        "authorized_official_telephone_number": "518-952-8408",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01420800",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.