NPIMap

Organization Active NPI

Family Medical Care of Bayshore, PC

  • Family Medicine Physician
  • Bay Shore, NY
National Provider Identifier
1487807061
Registry record updated Oct 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
210883 Issued in NY
Legal business name
FAMILY MEDICAL CARE OF BAYSHORE, PC
Practice address
1745 Union Blvd
Bay Shore, NY 11706-7952
Phone
(631) 328-5560
Fax
(516) 328-5599
NPI assigned
Oct 28, 2008
Last updated
Oct 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2008

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

Authorized official

Name
Carla Canavire-Weber, D.ONPI 1578632899
Title
Owner
Phone
(631) 328-5560

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 Physician 207Q00000X 210883 NY Primary

Addresses

Primary practice location

1745 Union Blvd
Bay Shore, NY 11706-7952

Mailing address

1745 Union Blvd
Bay Shore, NY 11706-7952
Phone (631) 328-5560

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100304000763 NY Part B Supplier - Clinic/Group Practice 8921143751 Receives reassigned benefits from 3 practitioners
Practice locations: Bay Shore, NY

National Provider Directory

National Provider Directory

Locations

1745 Union Blvd
Ste 1
Bay Shore, NY 11706

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20167/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1487807061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 UNION BLVD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067952",
            "telephone_number": "631-328-5560",
            "fax_number": "516-328-5599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 UNION BLVD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067952",
            "telephone_number": "631-328-5560",
            "fax_number": "516-328-5599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CARE OF BAYSHORE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "CANAVIRE-WEBER",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-328-5560",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "210883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; 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.