NPIMap

Organization Active NPI

The Children's Medical Group PLLC

  • Pediatrics Physician
  • Kingston, NY
National Provider Identifier
1639439995
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
THE CHILDREN'S MEDICAL GROUP PLLC
Doing business as
The Children's Medical Group PLLC
Practice address
63 Hurley Ave
Kingston, NY 12401-2832
Phone
(845) 452-1700
Fax
(845) 452-1752
NPI assigned
May 21, 2012
Last updated
Oct 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Authorized official

Name
Kimberly Mayhew
Title
Chief Executive Officer
Phone
(845) 452-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

63 Hurley Ave
Kingston, NY 12401-2832

Mailing address

301 Manchester Rd Ste 105
Poughkeepsie, NY 12603-2587
Phone (845) 452-1700

Other names 1

  • The Children's Medical Group PLLC Doing business as

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
33D2037335The Children's Medical Group63 Hurley Avenue, Kingston, NY 12401Certificate of waiverMar 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
The Children's Medical Group PLLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

63 Hurley Ave
Saint Remy, NY 12401
Phone (845) 331-3881

NPI Registry JSON

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1639439995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MANCHESTER RD STE 105",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126032587",
            "telephone_number": "845-452-1700",
            "fax_number": "845-452-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 HURLEY AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124012832",
            "telephone_number": "845-452-1700",
            "fax_number": "845-452-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHILDREN'S MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "MAYHEW",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "845-452-1700"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Children's Medical Group PLLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Children's Medical Group PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.