NPIMap

Organization Active NPI

Progressive Medical PLLC

  • Internal Medicine Physician
  • Staten Island, NY
National Provider Identifier
1508413097
Registry record updated Dec 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PROGRESSIVE MEDICAL PLLC
Practice address
455 Jersey St
Staten Island, NY 10301-2976
Phone
(718) 524-5611
NPI assigned
Aug 20, 2019
Last updated
Dec 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2019

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

Authorized official

Name
Ellis Enabosi, MDNPI 1669866158
Title
Owner
Phone
(973) 280-9600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

455 Jersey St
Staten Island, NY 10301-2976

Mailing address

460 N Maple Ave
East Orange, NJ 07017-4674

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21053/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

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": "1566259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577059200000",
    "number": "1508413097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 N MAPLE AVE",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070174674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 JERSEY ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012976",
            "telephone_number": "718-524-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-20",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A",
        "authorized_official_last_name": "ENABOSI",
        "authorized_official_first_name": "ELLIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-280-9600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.