Colleen M Dibble, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

263695 Issued in NY

Practice address

624 McClellan St
Suite G02
Schenectady, NY 12304-1020

Phone

(518) 382-2203

Fax

(518) 382-2226

NPI assigned

Jun 24, 2006

Sex

Female

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 4

Other names 1

• Colleen M Crumlish Former name

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

Specialty

Internal Medicine

Education

Jefferson Medical College of Thomas Jefferson University, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ellis HospitalGroup PAC ID 5890607410, 250 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ellis Hospital Hospital, Schenectady, NY, CCN 330153
• Sunnyview Hospital and Rehabilitation Center Hospital, Schenectady, NY, CCN 330406

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 and National Provider Directory roles.

• Ellis Hospital

  • General Acute Care Hospital
  • Schenectady, NY
  • NPI 1487644993
  Medicare reassignment Care Compare group NPD
• Community Care Physicians, PLLC

  • Family Medicine Physician
  • Ballston Spa, NY
  • NPI 1548541246
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ellis Hospital

  • General Acute Care Hospital
  • Schenectady, NY
  • NPI 1487644993
  Care Compare affiliation
• Sunnyview Hospital and Rehabilitation Center

  • General Acute Care Hospital
  • Schenectady, NY
  • NPI 1578664470
  Care Compare affiliation

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462492800000",
    "number": "1548296221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN ST",
            "address_2": "SUITE G02",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-382-2203",
            "fax_number": "518-382-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 MCCLELLAN ST",
            "address_2": "SUITE G02",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041020",
            "telephone_number": "518-382-2203",
            "fax_number": "518-382-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBBLE",
        "first_name": "COLLEEN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-24",
        "last_updated": "2016-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "263695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUECROSS/BLUESHIELD",
            "identifier": "755CJ1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7367465",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "130603000000",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03561199",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "CRUMLISH",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Arun Kumar Dhingra, MD
• Nancy Robin Diamond, PT
• Shane Diamond, M.D.
• Nicole Diaz-Segarra, MD
• Christopher Thomas Dibble, M.D., M.S.
• Amy Kirsten Dicaprio, OTR/L
• Eric Joseph Dickson Jr., LMSW
• Stacey Ann Didio, RN
• Digestive Disease Assoc of Schenectady
• Doris T Diggs

• Internal Medicine Physician in Schenectady, NY
• Providers in Schenectady, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.