Emerth Lance Coburn, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

198832 Issued in NY

Practice address

21401 110TH Ave
Queens Village, NY 11429-1906

Phone

(929) 615-6447

Fax

(718) 276-4783

NPI assigned

Nov 2, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Internal Medicine

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fresh Meadows Physician Practice PLLCGroup PAC ID 0941657811, 33 clinicians

Peyman Younesi MD PLLCGroup PAC ID 4981860202, 98 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• White Plains Hospital Center Hospital, White Plains, NY, CCN 330304
• Sutton Park Center for Nursing and Rehabilitation Nursing home, New Rochelle, NY, CCN 335350

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CJHFBA

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Hope Center Operations LLC

  • Skilled Nursing Facility
  • Bronx, NY
  • NPI 1124410733

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

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.

• Fresh Meadows Physician Practice PLLC

  • Internal Medicine Physician
  • Jamaica, NY
  • NPI 1720775083

  Internal Medicine, NY

  Medicare reassignment Care Compare group NPD
• Peyman Younesi MD PLLC

  • Internal Medicine Physician
  • Fresh Meadows, NY
  • NPI 1891053328

  Internal Medicine, NY

  Medicare reassignment Care Compare group NPD
• Lagrangeville Medical PC

  • Internal Medicine Physician
  • Franklin Square, NY
  • NPI 1861153322

  Internal Medicine, NY

  Medicare reassignment NPD
• Medical Services of Northeastern Queens PLLC

  • Internal Medicine Physician
  • Jamaica, NY
  • NPI 1184311441

  Internal Medicine, NY

  Medicare reassignment NPD
• My Medical PC

  • Family Medicine Physician
  • Valley Cottage, NY
  • NPI 1518637891

  Family Medicine, NY

  Medicare reassignment NPD
• Py Medical PLLC

  • Pain Medicine Physician
  • Bronx, NY
  • NPI 1043081524

  Internal Medicine, NY

  Medicare reassignment NPD
• Izgel Medical Services PLLC

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1669645628

  Internal Medicine

  NPD (past) Authorized official
• Azimuth Medical PC

  • Physical Medicine & Rehabilitation Physician
  • Brooklyn, NY
  • NPI 1083918593
  NPD (past)
• Caricare

  • Internal Medicine Physician
  • Cambria Heights, NY
  • NPI 1063614485

  Internal Medicine

  NPD (past)
• Comprehensive Primary Family Medical Care of Ny, PLLC

  • Primary Care Clinic/Center
  • Far Rockaway, NY
  • NPI 1699065003
  NPD (past)
• Dwayne E. Rollins, MD, PC

  • Otolaryngology Physician
  • Saint Albans, NY
  • NPI 1033234828
  NPD (past)
• Marvin Moy MD PC

  • Physical Medicine & Rehabilitation Physician
  • Flushing, NY
  • NPI 1215227343
  NPD (past)

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

• Sutton Park Center for Nursing & Rehabilitation LLC

  • Skilled Nursing Facility
  • New Rochelle, NY
  • NPI 1376788513

  Nursing home

  Care Compare affiliation
• White Plains Hospital Medical Center

  • General Acute Care Hospital
  • White Plains, NY
  • NPI 1447255153

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1477544096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214-01 110TH AVENUE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "11429",
            "telephone_number": "718-276-4482",
            "fax_number": "718-276-4783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21401 110TH AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114291906",
            "telephone_number": "929-615-6447",
            "fax_number": "718-276-4783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "EMERTH",
        "middle_name": "LANCE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "198832",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "198832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01617674",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George James Clark, RPH
• Sandra Clark
• Clear Diagnostic Solutions Inc
• Clear Imaging, Inc.
• Joseph Clerisme, MD
• Anthony James Cogliano, L.M.S.W
• Joseph Cohen, M.D.
• Bessy Colin-Renonce, LPN
• Pauline Colquhoun-Edwards, RN
• John W Comeau, DPT

• Family Medicine Physician in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• 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.