Individual provider Active NPI

Barbara Gannon, M.D.

  • Pediatric Adolescent Medicine Physician
  • Washingtonville, NY
National Provider Identifier
1619085388
Registry record updated Jul 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
1783891 Issued in NY
Practice address
10 Weathervane Dr
Washingtonville, NY 10992-2242
Phone
(845) 634-7900
Fax
(845) 634-0632
NPI assigned
Aug 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 1783891 NY Primary

Addresses

Primary practice location

10 Weathervane Dr
Washingtonville, NY 10992-2242

Mailing address

10 Weathervane Dr
Washingtonville, NY 10992-2242
Phone (845) 634-7900

Other identifiers 1

IdentifierTypeStateIssuer
01280166MedicaidNY

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
I20160412001347 NY Practitioner - Pediatric Medicine 9739487554 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1783891NYMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Children'S Health Physicians, LLP Adolescent Medicine CurrentSince Feb 13, 2016 Accepting new patients
Boston Childrens Health Physicians LLP CurrentSince Feb 13, 2016 Accepting new patients

Locations

19 Bradhurst Ave
Hawthorne, NY 10532
Phone (914) 493-7235

10 Weathervane Dr
Washingtonville, NY 10992
Phone (845) 496-1966

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1619085388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WEATHERVANE DR",
            "city": "WASHINGTONVILLE",
            "state": "NY",
            "postal_code": "109922242",
            "telephone_number": "845-634-7900",
            "fax_number": "845-634-0632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WEATHERVANE DR",
            "city": "WASHINGTONVILLE",
            "state": "NY",
            "postal_code": "109922242",
            "telephone_number": "845-634-7900",
            "fax_number": "845-634-0632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "BARBARA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "1783891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01280166",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washingtonville, NY

Sources for this page

Verify at the official NPI Registry.