Active NPI
Claxton-Hepburn Medical Center
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Ogdensburg, NY
National Provider Identifier
1427119486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- 4401000H
- Legal business name
- CLAXTON-HEPBURN MEDICAL CENTER
- Practice address
- 214 King St
Ogdensburg, NY 13669-1142 - Phone
- (315) 393-8880
- Fax
- (315) 393-7250
- NPI assigned
- Dec 13, 2006
- Organization subpart
- Yes
- Parent organization
- CLAXTON HEPBURN MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Carrie Bova
- Title
- Revenue Cycle Director
- Phone
- (315) 713-5354
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 4401000H | NY | Primary |
Addresses
Primary practice location
214 King St
Ogdensburg, NY 13669-1142
Mailing address
214 King St
Ogdensburg, NY 13669-1142
Phone (315) 394-9718
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02966989 | Medicaid | NY | |
| 00354072 | Medicaid | NY |
Other names 1
- Dr. Ravinder Agarwal Renal Center
National Provider Directory
National Provider Directory- Part of
- Claxton Hepburn Medical Center
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1629849600000",
"number": "1427119486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "214 KING ST",
"city": "OGDENSBURG",
"state": "NY",
"postal_code": "136691142",
"telephone_number": "315-394-9718",
"fax_number": "315-393-7250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 KING ST",
"city": "OGDENSBURG",
"state": "NY",
"postal_code": "136691142",
"telephone_number": "315-393-8880",
"fax_number": "315-393-7250"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CLAXTON-HEPBURN MEDICAL CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CLAXTON HEPBURN MEDICAL CENTER",
"enumeration_date": "2006-12-13",
"last_updated": "2021-08-25",
"certification_date": "2021-08-25",
"status": "A",
"authorized_official_last_name": "BOVA",
"authorized_official_first_name": "CARRIE",
"authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
"authorized_official_telephone_number": "315-713-5354"
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "NY",
"license": "4401000H",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02966989",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00354072",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Dr. Ravinder Agarwal Renal Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ogdensburg, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.