Individual provider Active NPI

Brian Glenn Timm, DPM

  • Foot & Ankle Surgery Podiatrist
  • Binghamton, NY
National Provider Identifier
1457597106
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
AN006710 Issued in NY
Practice address
161 Riverside Dr
Suite M08
Binghamton, NY 13905-4176
Phone
(607) 723-7454
Fax
(607) 723-1567
NPI assigned
Dec 31, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X AN006710 NY Primary

Addresses

Primary practice location

161 Riverside Dr
Suite M08
Binghamton, NY 13905-4176

Mailing address

161 Riverside Dr
Suite M08
Binghamton, NY 13905-4176
Phone (607) 723-7454

Other identifiers 1

IdentifierTypeStateIssuer
3608100MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address brian.timm@direct.lourdes.com Direct

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150617002476 NY Practitioner - Podiatry 9234287145 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Our Lady of Lourdes Memorial Hospital IncGroup PAC ID 1254237779, 249 clinicians

Practice addresses (Care Compare)

161 Riverside Dr
Suite M05
Binghamton, NY 13905-4112
Phone (607) 798-5442

Hospital & facility affiliations

  • Our Lady of Lourdes Memorial Hospital, Inc Hospital, Binghamton, NY, CCN 330011
  • United Health Services Hospitals, Inc Hospital, Binghamton, NY, CCN 330394
  • Guthrie Cortland Regional Medical Center Hospital, Cortland, NY, CCN 330175

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue38
Removal of skin lesions1-10
Removal of nail tissue627
Removal or shaving of skin growth19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AN006710NYMDFoot & Ankle Surgery Podiatrist
006710NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Twin Tier Pathology Associates, PC Current Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Oct 1, 2018 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. Current Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. CurrentSince Oct 1, 2018 Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

161 Riverside Dr
Ste M05
Binghamton, NY 13905
Phone (607) 770-7074

169 Riverside Dr
#L
Binghamton, NY 13905
Phone (607) 798-5474

161 Riverside Dr
Ste M08
Binghamton, NY 13905
Phone (607) 723-7454

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

500 5th Ave
Owego, NY 13827
Phone (607) 687-1122

Interoperability endpoints

  • Direct secure messaging: btimm196873@direct-guthrie.org

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.

Hospital & facility affiliations 3

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": "1230681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1457597106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 RIVERSIDE DR",
            "address_2": "SUITE M08",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139054176",
            "telephone_number": "607-723-7454",
            "fax_number": "607-723-1567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 RIVERSIDE DR",
            "address_2": "SUITE M08",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139054176",
            "telephone_number": "607-723-7454",
            "fax_number": "607-723-1567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMM",
        "first_name": "BRIAN",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-31",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NY",
            "license": "AN006710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3608100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "brian.timm@direct.lourdes.com",
            "affiliation": "N",
            "endpointDescription": "Lourdes Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "161 Riverside Dr",
            "address_2": "Suite M08",
            "city": "Binghamton",
            "state": "NY",
            "country_code": "US",
            "postal_code": "139054176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Binghamton, NY

Sources for this page

Verify at the official NPI Registry.