Raphael T Tshibangu, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

1395531 Issued in NY

Practice address

990 South Avenue
Suite 104
Rochester, NY 14620

Phone

(585) 256-3000

Fax

(585) 256-3045

NPI assigned

Mar 9, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeast OB-GYN PC

  dba Southeast Obstetrics & Gynecology PC

  • Obstetrics & Gynecology Physician
  • Rochester, NY
  • NPI 1184764524
  Medicare reassignment NPD

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518935378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 SOUTH AVENUE",
            "address_2": "SUITE 104",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14620",
            "telephone_number": "585-256-3000",
            "fax_number": "585-256-3045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 SOUTH AVENUE",
            "address_2": "SUITE 104",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14620",
            "telephone_number": "585-256-3000",
            "fax_number": "585-256-3045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSHIBANGU",
        "first_name": "RAPHAEL",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "1395531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4345433",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "100876CK",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "2918",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00927591",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10511426",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Tsavaris, AGACNP
• James H Tsay, PHARM.D, M.B.A.
• Brittany Tschanz
• Beth D Tschorke, PT
• Joseph Tshamala, DC
• Alexandra Tsigarida, DDS, MS
• Georgios Tsoulfas
• John H Tu, MD
• Lydie Tshiyoyo Tubene, OD
• Andrew Joseph Tubiolo, DPM

• Obstetrics & Gynecology Physician in Rochester, NY
• Providers in Rochester, NY by specialty
• Obstetrics & Gynecology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.