NPIMap

Organization Active NPI

Vail Healthcare Medical PLLC

  • Family Medicine Physician
  • Bronx, NY
National Provider Identifier
1487051207
Registry record updated Apr 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
186141 Issued in NY
Legal business name
VAIL HEALTHCARE MEDICAL PLLC
Practice address
1070 Southern Blvd
Bronx, NY 10459-3268
Phone
(718) 589-4541
Fax
(718) 893-8511
NPI assigned
Nov 21, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2015

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

Authorized official

Name
Dr. Samuel A Deleon, MDNPI 1770589111
Title
President
Phone
(718) 589-4541

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 186141 NY Primary

Addresses

Primary practice location

1070 Southern Blvd
Bronx, NY 10459-3268

Mailing address

1070 Southern Blvd
Bronx, NY 10459-3268
Phone (718) 589-4541

Other names 1

  • Multi Medic Physicians Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150707000124 NY Part B Supplier - Clinic/Group Practice 9436461399 Receives reassigned benefits from 16 practitioners
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory
Tax ID family
Multi Medic Physicians Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

953 Southern Blvd
Rm 202
Bronx, NY 10459
Phone (718) 589-4541

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1416528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1487051207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104593268",
            "telephone_number": "718-589-4541",
            "fax_number": "718-893-8511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104593268",
            "telephone_number": "718-589-4541",
            "fax_number": "718-893-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAIL HEALTHCARE MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-21",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "DELEON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-589-4541",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "186141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Multi Medic Physicians Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.