Individual provider Active NPI

Budiarto Ranoewidjojo, D.O.

  • Emergency Medicine Physician
  • New York, NY
National Provider Identifier
1417187352
Registry record updated Jul 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
253948 Issued in NY
Practice address
506 Lenox Ave
New York, NY 10037-1802
Phone
(212) 939-2251
NPI assigned
Jul 24, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 253948 NY Primary

Addresses

Primary practice location

506 Lenox Ave
New York, NY 10037-1802

Mailing address

134 Haven Ave Apt 3B
New York, NY 10032-1126
Phone (909) 319-5342

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
I20091030000521 NY Practitioner - Emergency Medicine 2668519257 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

336 E 86TH St
New York, NY 10028-4615
Phone (212) 772-3627

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
253948NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harlem Medical Associates PC CurrentSince Jan 1, 2011 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Jun 27, 2014 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince Jun 27, 2014 Accepting new patients
City Medical of Upper East Side, PLLC Current Accepting new patients

Locations

3111 Steinway St
Astoria, NY 11103
Phone (718) 475-2345

336 E 86th St
New York, NY 10028
Phone (212) 772-3627

506 Malcolm X Blvd
#522
New York, NY 10037
Phone (212) 491-1583

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

561 3rd Ave
New York, NY 10016
Phone (212) 729-4668

1345 Rxr Plz
Uniondale, NY 11556
Phone (516) 453-0435

Interoperability endpoints

  • Direct secure messaging: budiarto.ranoewidjojo.1@2983.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248393600000",
    "number": "1417187352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 HAVEN AVE APT 3B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321126",
            "telephone_number": "909-319-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 LENOX AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100371802",
            "telephone_number": "212-939-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANOEWIDJOJO",
        "first_name": "BUDIARTO",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-24",
        "last_updated": "2009-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "253948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.