Active NPI
Domiciano Patacsil, MD
- Anatomic Pathology Physician
- Albany, NY
National Provider Identifier
1649209735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology Physician
- License
- 134434
- Practice address
- 400 Patroon Creek Blvd
Suite 101
Albany, NY 12206 - Phone
- (518) 435-8360
- Fax
- (518) 435-8391
- NPI assigned
- Jul 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 134434 | NY | |
| Anatomic Pathology Physician | 207ZP0101X | 134434 | NY | Primary |
Addresses
Primary practice location
400 Patroon Creek Blvd
Suite 101
Albany, NY 12206
Mailing address
400 Patroon Creek Blvd
Suite 101
Albany, NY 12206
Phone (518) 435-8360
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01332067 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 134434 | NY | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Emergency Medical Associates, PC | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Schenectady, NY
- NPI 1003844606
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204588800000",
"number": "1649209735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 PATROON CREEK BLVD",
"address_2": "SUITE 101",
"city": "ALBANY",
"state": "NY",
"postal_code": "12206",
"telephone_number": "518-435-8360",
"fax_number": "518-435-8391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 PATROON CREEK BLVD",
"address_2": "SUITE 101",
"city": "ALBANY",
"state": "NY",
"postal_code": "12206",
"telephone_number": "518-435-8360",
"fax_number": "518-435-8391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATACSIL",
"first_name": "DOMICIANO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-01",
"last_updated": "2008-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NY",
"license": "134434",
"primary": false
},
{
"code": "207ZP0101X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology",
"state": "NY",
"license": "134434",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01332067",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.