NPIMap

Individual provider Active NPI

Paul Hodgeman, RPAC

  • Physician Assistant
  • Johnson City, NY
National Provider Identifier
1588734024
Registry record updated Nov 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
006485 Issued in NY
Practice address
30 Harrison St
Suite 460
Johnson City, NY 13790-2161
Phone
(607) 763-8101
Fax
(607) 763-8049
NPI assigned
Nov 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 006485 NY Primary

Addresses

Primary practice location

30 Harrison St
Suite 460
Johnson City, NY 13790-2161

Mailing address

346 Grand Ave
Johnson City, NY 13790-2580
Phone (607) 763-8101

Other identifiers 1

IdentifierTypeStateIssuer
01965613MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110112000039 NY Practitioner - Physician Assistant 7113116815 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mobile Physician Services PLLCGroup PAC ID 8325360290, 104 clinicians

Practice addresses (Care Compare)

40 La Riviere Dr
Suite 201
Buffalo, NY 14202-4036
Phone 7168931010210

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
006485NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital, Inc. Physician Assistant CurrentSince Dec 7, 1998 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Dec 7, 1998 Accepting new patients
Mobile Physician Services PLLC PastSince Jun 30, 2026 Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

39 E Main St
Hancock, NY 13783
Phone (607) 637-5700

Organizations & group practices 8

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415750400000",
    "number": "1588734024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "346 GRAND AVE",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902580",
            "telephone_number": "607-763-8101",
            "fax_number": "607-763-8049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HARRISON ST",
            "address_2": "SUITE 460",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902161",
            "telephone_number": "607-763-8101",
            "fax_number": "607-763-8049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGEMAN",
        "first_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "RPAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2014-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "006485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01965613",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, NY

Sources for this page

Verify at the official NPI Registry.