Individual provider Active NPI

Robert Feldman, MD

  • Family Medicine Physician
  • Fayetteville, NY
National Provider Identifier
1508965484
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
189128 Issued in NY
Practice address
4101 Medical Center Dr
Fayetteville, NY 13066-6600
Phone
(315) 637-7878
Fax
(315) 637-7808
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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 189128 NY Primary

Addresses

Primary practice location

4101 Medical Center Dr
Fayetteville, NY 13066-6600

Mailing address

4101 Medical Center Dr
Fayetteville, NY 13066-6600
Phone (315) 637-7878

Other identifiers 2

IdentifierTypeStateIssuer
J400005496OtherNYPTAN # NORTH MEDICAL, PC
00355266MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090908000504 NY Practitioner - Family Practice 7214082650 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Josephs Medical PC Family Medicine CurrentSince Jan 1, 2011 Accepting new patients
North Medical PC Family Medicine Current Accepting new patients
Genesee Valley Group Health Association Past Accepting new patients
Cny North Urgent Care PLLC Past Accepting new patients

Locations

4101 Medical Center Dr
Fayetteville, NY 13066
Phone (315) 637-7878

5100 W Taft Rd
Ste 1D
Liverpool, NY 13088
Phone (315) 452-2828

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

5100 W Taft Rd
Ste 4F
Liverpool, NY 13088
Phone (315) 234-9171

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1508965484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 MEDICAL CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666600",
            "telephone_number": "315-637-7878",
            "fax_number": "315-637-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 MEDICAL CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666600",
            "telephone_number": "315-637-7878",
            "fax_number": "315-637-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELDMAN",
        "first_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "189128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN # NORTH MEDICAL, PC",
            "identifier": "J400005496",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00355266",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NY

Sources for this page

Verify at the official NPI Registry.