NPIMap

Individual provider Active NPI

Marc Immerman, M.D.

  • General Practice Physician
  • Elmira, NY
National Provider Identifier
1417967712
Registry record updated Feb 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
174214 Issued in NY
Practice address
1003 Walnut St
Elmira, NY 14901-1007
Phone
(607) 732-5646
Fax
(607) 732-0373
NPI assigned
Aug 9, 2006
Last updated
Feb 6, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 174214 NY
General Practice Physician 208D00000X 174214 NY Primary

Addresses

Primary practice location

1003 Walnut St
Elmira, NY 14901-1007

Mailing address

1003 Walnut St
Elmira, NY 14901-1007
Phone (607) 732-5646

Other identifiers 2

IdentifierTypeStateIssuer
000915192004OtherNYBCBS
01144467MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050831000185 NY Practitioner - Family PracticePractitioner - Emergency Medicine 4183656077 Reassigns benefits to 3 organizations
Practice locations: Elmira, NY

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
University of Vermont College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chemung-Schuyler Counties Chapter, Nysarc, IncGroup PAC ID 3577980622, 17 clinicians

Practice addresses (Care Compare)

711 Sullivan St
Elmira, NY 14901-2322
Phone (607) 734-6151

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Chemung-Schuyler Counties Chapter, Nysarc, Inc. CurrentSince Jul 5, 2020 Accepting new patients
Nes Medical Services of New York PC Emergency Medicine CurrentSince May 22, 2022 Accepting new patients
Nes Medical Services of New York PC Emergency Medicine CurrentSince Dec 4, 2019 Accepting new patients
Delphi Healthcare PLLC Emergency Medicine Past Accepting new patients
Southern Tier Emergency Physicians Emergency Medicine Past Accepting new patients
Emergency Physician Services of New York, P.C. Emergency Medicine Past Accepting new patients
Finger Lakes Emergency Physicians Emergency Medicine Past Accepting new patients
Delphi Emergency Physician Services Past Accepting new patients
Exigence Medical of Hornell, PLLC Emergency Medicine Past Accepting new patients

Locations

7571 State Route 54
Bath, NY 14810
Phone (607) 776-8500

555 Saint Josephs Blvd
Elmira, NY 14901
Phone (607) 733-6541

711 Sullivan St
Elmira, NY 14901
Phone (607) 535-6934

240 Oconnor St
Wellsville, NY 14895
Phone (585) 593-3005

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517875200000",
    "number": "1417967712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 WALNUT ST",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149011007",
            "telephone_number": "607-732-5646",
            "fax_number": "607-732-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 WALNUT ST",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149011007",
            "telephone_number": "607-732-5646",
            "fax_number": "607-732-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMMERMAN",
        "first_name": "MARC",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2018-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "174214",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "174214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000915192004",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01144467",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmira, NY

Sources for this page

Verify at the official NPI Registry.