Organization Active NPI

Summit Medical PC

  • Anesthesiology Physician
  • Bayside, NY
National Provider Identifier
1487939856
Registry record updated Dec 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
207025 Issued in NY
Legal business name
SUMMIT MEDICAL PC
Practice address
21333 39TH Ave
Suite 248
Bayside, NY 11361-2091
Phone
(718) 428-5333
Fax
(718) 428-5332
NPI assigned
Oct 18, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2011

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

Authorized official

Name
Dr. Won Sohn, M.D.NPI 1689626103
Title
Owner
Phone
(718) 428-5333

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
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X 207025 NY Primary

Addresses

Primary practice location

21333 39TH Ave
Suite 248
Bayside, NY 11361-2091

Mailing address

PO Box 270
Massapequa Park, NY 11762-0270
Phone (631) 264-2035

Other identifiers 1

IdentifierTypeStateIssuer
02088860MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120126000839 NY Part B Supplier - Clinic/Group Practice 6507033834 Receives reassigned benefits from 6 practitioners
Practice locations: Bayside, NY; Brooklyn, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324252800000",
    "number": "1487939856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "MASSAPEQUA PARK",
            "state": "NY",
            "postal_code": "117620270",
            "telephone_number": "631-264-2035",
            "fax_number": "631-264-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21333 39TH AVE",
            "address_2": "SUITE 248",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113612091",
            "telephone_number": "718-428-5333",
            "fax_number": "718-428-5332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-18",
        "last_updated": "2011-12-19",
        "status": "A",
        "authorized_official_last_name": "SOHN",
        "authorized_official_first_name": "WON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-428-5333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "207025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02088860",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.