NPIMap

Individual provider Active NPI

Antonio Gregorian, MD

  • Family Medicine Physician
  • Clifton Park, NY
National Provider Identifier
1487740080
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
203401 Issued in NY
Practice address
1 Tallow Wood Dr
Clifton Park, NY 12065-2807
Phone
(518) 373-4500
Fax
(518) 723-2097
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 203401 NY Primary

Addresses

Primary practice location

1 Tallow Wood Dr
Clifton Park, NY 12065-2807

Mailing address

PO Box 14890
Albany, NY 12212-4890
Phone (518) 525-5634

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090819000328 NY Practitioner - Family Practice 2769536101 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Samaritan Hospital of Troy, New YorkGroup PAC ID 6507770070, 258 clinicians

Practice addresses (Care Compare)

1 Tallow Wood Dr
Clifton Park, NY 12065-2807
Phone (518) 688-0295

Hospital & facility affiliations

  • Eddy Visiting Nurse & Rehab Association Home health agency, Troy, NY, CCN 337203
  • Marquis Certified Home Care, LLC Home health agency, Albany, NY, CCN 337418
  • Community Hospice, Inc, the Hospice, Albany, NY, CCN 331501
  • Samaritan Hospital of Troy, New York Hospital, Troy, NY, CCN 330180
  • St Peter'S Hospital Hospital, Albany, NY, CCN 330057
  • Sunnyview Hospital and Rehabilitation Center Hospital, Schenectady, NY, CCN 330406

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Hospital of Troy, New York Family Medicine CurrentSince Jan 1, 2019 Accepting new patients

Locations

600 Northern Blvd
Albany, NY 12204
Phone (518) 427-3331

1 Tallow Wood Dr
Clifton Park, NY 12065
Phone (518) 373-4444

713 Troy Schenectady Rd
Ste 304
Latham, NY 12110
Phone (518) 373-4448

2 Empire Dr
Ste 202
Rensselaer, NY 12144
Phone (518) 286-4990

2215 Burdett Ave
Troy, NY 12180
Phone (518) 271-3300

147 Hoosick St
Troy, NY 12180
Phone (518) 268-5749

Interoperability endpoints

  • Direct secure messaging: agregorian834561@direct.trinity-health.org

Organizations & group practices 1

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 7

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1487740080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "518-525-5634",
            "fax_number": "518-649-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 TALLOW WOOD DR",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120652807",
            "telephone_number": "518-373-4500",
            "fax_number": "518-723-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREGORIAN",
        "first_name": "ANTONIO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "203401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1 Tallow Wood Dr",
            "city": "Clifton Park",
            "state": "NY",
            "country_code": "US",
            "postal_code": "120652807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clifton Park, NY

Sources for this page

Verify at the official NPI Registry.