NPIMap

Organization Active NPI

New York Pain Management PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Clifton Park, NY
National Provider Identifier
1407884455
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
NEW YORK PAIN MANAGEMENT PLLC
Practice address
9 Old Plank Rd
Clifton Park, NY 12065-3107
Phone
(518) 371-0777
NPI assigned
Jun 29, 2006
Last updated
Sep 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

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

Authorized official

Name
Charles Gordon, MDNPI 1649243890
Title
President
Phone
(518) 371-0777

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
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

9 Old Plank Rd
Clifton Park, NY 12065-3107

Mailing address

9 Old Plank Rd
Suite 100
Clifton Park, NY 12065-3107
Phone (518) 283-5418

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000634 NY Part B Supplier - Clinic/Group Practice 8325945199 Receives reassigned benefits from 12 practitioners
Practice locations: Clifton Park, NY; Queensbury, NY
O20241218001419 NY DME Supplier - Physician - Interventional Pain Management 8325945199 Practice locations: Clifton Park, 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
33D1010866New York Pain Management PLLC9 Old Plank Rd, Clifton Park, NY 12065Certificate of waiverMar 24, 2027

National Provider Directory

National Provider Directory

Locations

9 Old Plank Rd
Clifton Park, NY 12065
Phone (518) 371-0777

9 Old Plank Rd
#100
Clifton Park, NY 12065
Phone (518) 371-0777

711 Troy Schenectady Rd
Ste 207
Latham, NY 12110
Phone (518) 220-9575

375 Bay Rd
Queensbury, NY 12804
Phone (518) 741-0043

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315526400000",
    "number": "1407884455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 OLD PLANK RD",
            "address_2": "SUITE 100",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653107",
            "telephone_number": "518-283-5418",
            "fax_number": "518-283-5421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 OLD PLANK RD",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653107",
            "telephone_number": "518-371-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK PAIN MANAGEMENT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2011-09-09",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-371-0777",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; 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.