NPIMap

Organization Active NPI

Trumansburg Medicine PLLC

  • Family Medicine Physician
  • Trumansburg, NY
National Provider Identifier
1528056942
Registry record updated Feb 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRUMANSBURG MEDICINE PLLC
Practice address
4435 Seneca Rd
Trumansburg, NY 14886-9201
Phone
(607) 387-5707
Fax
(607) 387-4354
NPI assigned
Oct 10, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2014

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

Authorized official

Name
John D. Cooke, MDNPI 1427046853
Title
Member/Owner
Phone
(607) 387-5707

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4435 Seneca Rd
Trumansburg, NY 14886-9201

Mailing address

4435 Seneca Rd
Trumansburg, NY 14886-9201
Phone (607) 387-5707

Other identifiers 1

IdentifierTypeStateIssuer
02863638MedicaidNY

Other names 1

  • Trumansburg Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070730000594 NY Part B Supplier - Clinic/Group Practice 5395846794 Receives reassigned benefits from 11 practitioners
Practice locations: Ithaca, NY; Trumansburg, NY

National Provider Directory

National Provider Directory

Locations

1018 Ellis Hollow Rd
Ste C
Ithaca, NY 14850
Phone (607) 387-5707

1018 Ellis Hollow Rd
Ithaca, NY 14850
Phone (607) 272-5151

4435 Seneca Rd
#H
Trumansburg, NY 14886
Phone (607) 387-5707

4435 Seneca Rd
Trumansburg, NY 14886
Phone (607) 387-5707

Practitioners & affiliated clinicians

Practitioners 11

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": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391644800000",
    "number": "1528056942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4435 SENECA RD",
            "city": "TRUMANSBURG",
            "state": "NY",
            "postal_code": "148869201",
            "telephone_number": "607-387-5707",
            "fax_number": "607-387-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 SENECA RD",
            "city": "TRUMANSBURG",
            "state": "NY",
            "postal_code": "148869201",
            "telephone_number": "607-387-5707",
            "fax_number": "607-387-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUMANSBURG MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2014-02-06",
        "status": "A",
        "authorized_official_last_name": "COOKE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "607-387-5707",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02863638",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trumansburg Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trumansburg, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; 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.