Carol Dimond, MD
Individual provider Active NPI Internal Medicine Physician · Tupper Lake, NY
NPI 1508904103 · NPPES record last updated Jul 20, 2010
Key facts
- NPI
- 1508904103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 155797 (NY)
- Practice address
- 2445 State Route 30
Sunmount Ddso
Tupper Lake, NY 12986-2502 - Phone
- (518) 359-7701
- Fax
- (518) 359-4133
- NPI assigned
- Feb 3, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150930001958 | NY | Order and Referring Only - Internal Medicine |
5698810604 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lyons Medical Care, PLLC | Internal Medicine | Past | Accepting new patients |
| State of New York Comptrollers Office | Past | Accepting new patients | |
| Practice Associates,Inc | Internal Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 155797 | NY | Yes |
Addresses
Primary practice location
2445 State Route 30
Sunmount Ddso
Tupper Lake, NY 12986-2502
Mailing address
2445 State Route 30
Sunmount Ddso
Tupper Lake, NY 12986-2502
Phone (518) 359-7701
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01183251 | Medicaid | NY |
NPI Registry JSON
{
"created_epoch": "1170460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279584000000",
"number": "1508904103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2445 STATE ROUTE 30",
"address_2": "SUNMOUNT DDSO",
"city": "TUPPER LAKE",
"state": "NY",
"postal_code": "129862502",
"telephone_number": "518-359-7701",
"fax_number": "518-359-4133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2445 STATE ROUTE 30",
"address_2": "SUNMOUNT DDSO",
"city": "TUPPER LAKE",
"state": "NY",
"postal_code": "129862502",
"telephone_number": "518-359-7701",
"fax_number": "518-359-4133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIMOND",
"first_name": "CAROL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-03",
"last_updated": "2010-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "155797",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01183251",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tupper Lake, NY
- Jules Comeau
- Vincent Connors
- Eileen Dattola
- Margaret D Dechene
- Haley Mae Del Duca
- Janelle Edwards
- Mary Lynne Feller
- Franklin Hamilton Chapter Nysarc
- Melinda Sue Frazer
- Aimee Fredette
All providers in Tupper Lake, NY · Internal Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.