Organization Active NPI

Cardinal Family Medicine, PLLC

  • Family Medicine Physician
  • Montgomery, NY
National Provider Identifier
1396458642
Registry record updated Dec 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CARDINAL FAMILY MEDICINE, PLLC
Practice address
20 Walnut St Ste C
Montgomery, NY 12549-2261
Phone
(845) 287-0037
Fax
(845) 764-9510
NPI assigned
Jan 3, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2024

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

Authorized official

Name
Dr. Alexandria Danielle Howard, MDNPI 1336430545
Title
Owner
Phone
(216) 526-9619

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

20 Walnut St Ste C
Montgomery, NY 12549-2261

Mailing address

97 Enterprise Dr # 11144
Newburgh, NY 12550-8335

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230329001945 NY Part B Supplier - Clinic/Group Practice 0143694364 Receives reassigned benefits from 1 practitioner
Practice locations: Montgomery, NY

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
33D2285684Cardinal Family Medicine, PLLC20 Walnut St, Ste C, Montgomery, NY 12549Certificate of waiverJul 16, 2027

National Provider Directory

National Provider Directory

Locations

153 Ward St
Montgomery, NY 12549
Phone (845) 287-0037

97 Enterprise Dr
Unit 11144
Newburgh, NY 12550

97 Enterprise Dr
#11144
Newburgh, NY 12550

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735344000000",
    "number": "1396458642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 ENTERPRISE DR # 11144",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125508335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WALNUT ST STE C",
            "city": "MONTGOMERY",
            "state": "NY",
            "postal_code": "125492261",
            "telephone_number": "845-287-0037",
            "fax_number": "845-764-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDINAL FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-03",
        "last_updated": "2024-12-28",
        "certification_date": "2024-12-28",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "ALEXANDRIA",
        "authorized_official_middle_name": "DANIELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "216-526-9619",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2024; 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.