Individual provider Active NPI

Danielle Renodin-Mead, DO

  • Pediatrics Physician
  • Brockport, NY
National Provider Identifier
1548569916
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
276958 Issued in NY
Practice address
300 West Ave
Brockport, NY 14420-1118
Phone
(585) 637-3905
Fax
(585) 637-2375
NPI assigned
Mar 24, 2011
Last updated
Aug 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 276958 NY Primary

Addresses

Primary practice location

300 West Ave
Brockport, NY 14420-1118

Mailing address

300 West Ave
Brockport, NY 14420-1118
Phone (585) 637-3905

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
I20191018000819 NY Practitioner - Pediatric Medicine 2062743271 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Orchard Community Health Center Inc CurrentSince Sep 2, 2019 Accepting new patients
Oak Orchard Community Health Center Inc. CurrentSince Sep 2, 2019 Accepting new patients

Locations

300 West Ave
Brockport, NY 14420
Phone (585) 637-3905

Interoperability endpoints

  • Direct secure messaging: danielle.renodinmead@oochc.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Oak Orchard HealthHornell, NY, CCN 331195 Federally qualified health center W-2 Managing Employee Jul 6, 2015
The Wellness Center at Oak OrchardAlbion, NY, CCN 571197 Federally qualified health center W-2 Managing Employee Jul 8, 2015
Oak Orchard Community Health Center, Inc.Alexander, NY, CCN 571804 Federally qualified health center W-2 Managing Employee Jul 6, 2015
Oak Orchard Community Health Center, Inc.Corfu, NY, CCN 571803 Federally qualified health center W-2 Managing Employee Jul 6, 2015
Oak Orchard Community Health Center, Inc.Batavia, NY, CCN 571802 Federally qualified health center W-2 Managing Employee Jul 6, 2015

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1548569916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201118",
            "telephone_number": "585-637-3905",
            "fax_number": "585-637-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201118",
            "telephone_number": "585-637-3905",
            "fax_number": "585-637-2375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENODIN-MEAD",
        "first_name": "DANIELLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-24",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "276958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockport, NY

Sources for this page

Verify at the official NPI Registry.