Individual provider Active NPI

Michael P Morin, M.D.

  • Pediatrics Physician
  • Albany, NY
National Provider Identifier
1396831764
Registry record updated Jan 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
177463 Issued in NY
Practice address
6 Executive Park Dr
Albany, NY 12203-3791
Phone
(518) 641-6319
Fax
(518) 641-6850
NPI assigned
Oct 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 177463 NY Primary

Addresses

Primary practice location

6 Executive Park Dr
Albany, NY 12203-3791

Mailing address

711 Troy Schenectady Rd Ste 203
Latham, NY 12110-2461
Phone (518) 782-3700

Other identifiers 9

IdentifierTypeStateIssuer
711043OtherNYMVP
72670OtherNYGHI/HMO
070123000054OtherNYFIDELIS
193AS1OtherNYEMPIRE BC
5002022OtherNYAETNA
000401053014OtherNYBSNENY
10006143OtherNYCDPHP
200094OtherNYSENIOR WHOLE HEALTH
01249834MedicaidNY

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
I20040420000326 NY Practitioner - Pediatric Medicine 2466447230 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
177463NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Physicians, PLLC Pediatrics CurrentSince Nov 1, 2017 Accepting new patients
Community Care Physicians, PLLC Past Accepting new patients

Locations

501 New Karner Rd
Ste 1A
Albany, NY 12205
Phone (518) 452-1337

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

20 Prospect St
Ste 106
Ballston Spa, NY 12020
Phone (518) 855-3755

711 Troy Schenectady Rd
Ste 210
Latham, NY 12110

6 Wellness Way
Ste 201
Latham, NY 12110
Phone (518) 782-3900

711 Troy Schenectady Rd
Ste 203
Latham, NY 12110
Phone (518) 782-3742

3732 Carman Rd
Schenectady, NY 12303
Phone (518) 356-4132

6 Executive Park Dr
Stuyvesant Plaza, NY 12203
Phone (518) 482-9111

Interoperability endpoints

  • Direct secure messaging: mmorin788383@direct.trinity-health.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1396831764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 EXECUTIVE PARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033791",
            "telephone_number": "518-641-6319",
            "fax_number": "518-641-6850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORIN",
        "first_name": "MICHAEL",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "177463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "711043",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI/HMO",
            "identifier": "72670",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "070123000054",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC",
            "identifier": "193AS1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5002022",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSNENY",
            "identifier": "000401053014",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10006143",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENIOR WHOLE HEALTH",
            "identifier": "200094",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01249834",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.