NPIMap

Organization Active NPI

Perry Ave Family Medical Center Inc

  • Family Medicine Physician
  • Bronx, NY
National Provider Identifier
1619973518
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PERRY AVE FAMILY MEDICAL CENTER INC
Practice address
3071 Perry Ave
Bronx, NY 10467-4111
Phone
(718) 231-6700
Fax
(718) 515-5454
NPI assigned
Jun 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

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

Authorized official

Name
Mrs. Shama R Khan
Title
Operations Manager
Phone
(718) 231-6700

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207KA0200X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

3071 Perry Ave
Bronx, NY 10467-4111

Mailing address

3071 Perry Ave
Bronx, NY 10467-4111
Phone (718) 231-6700

Other identifiers 6

IdentifierTypeStateIssuer
02444553MedicaidNY
2000416OtherNYGHI
7829562OtherNYAETNA
S70F11OtherNYBLUE CROSS
041227000012OtherNYFIDELIS
2478450OtherNYUNITED HEALTH CARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080131000457 NY Part B Supplier - Clinic/Group Practice 0547365363 Receives reassigned benefits from 84 practitioners
Practice locations: Bronx, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2277450Perry Avenue Family Medical Center Inc3071 Perry Ave, Bronx, NY 10467Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 85

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436313600000",
    "number": "1619973518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3071 PERRY AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104674111",
            "telephone_number": "718-231-6700",
            "fax_number": "718-515-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3071 PERRY AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104674111",
            "telephone_number": "718-231-6700",
            "fax_number": "718-515-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY AVE FAMILY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2015-07-08",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "SHAMA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "718-231-6700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02444553",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2000416",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7829562",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "S70F11",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "041227000012",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2478450",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.