Shailesh Suresh Pathare, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

205677-1 Issued in NY

Practice address

565 Jewett Ave
Staten Island, NY 10302-2654

Phone

(718) 701-6010

Fax

(718) 447-7831

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 9

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

Physical Medicine and RehabilitationAlso: Interventional Pain Management

Education

State University of Ny Upstate Medical University, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Advanced Spine Care and Pain Management of New York PC

  • Specialist
  • Staten Island, NY
  • NPI 1124102603
  Medicare reassignment Authorized official
• Sathish R. Modugu Medical PC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Hartsdale, NY
  • NPI 1851403935
  Medicare reassignment NPD
• Steiger NP in Acute Care PLLC

  • Acute Care Nurse Practitioner
  • Wappingers Falls, NY
  • NPI 1770315434
  NPD (past)

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1487738829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 JEWETT AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103022654",
            "telephone_number": "718-701-6010",
            "fax_number": "718-447-7831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 JEWETT AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103022654",
            "telephone_number": "718-701-6010",
            "fax_number": "718-447-7831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATHARE",
        "first_name": "SHAILESH",
        "middle_name": "SURESH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2021-05-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "205677-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC BS",
            "identifier": "0012J1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ELDERPLAN",
            "identifier": "173446",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "205677",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "355618300",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P1883750",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02006962",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHS/HEALTHNET",
            "identifier": "4C4399",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "8799893",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00006210",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robyn Carissa Patella, MS, RPA-C
• Maria Paterno
• Philip Salvatore Paterno, P.A.-C.
• Antonette Paternostro
• Rahul Shivaji Pathak, M.D.
• Pathmark
• Pathmark Stores Inc
• Pathmark Stores Inc
• Pathmark Stores Inc
• Pathmark Stores Inc

• Specialist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.