Active NPI
Amerigroup New York, LLC
Doing business as AMERIGROUP Community Care
- Health Maintenance Organization
- New York, NY
National Provider Identifier
1649254806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Maintenance Organization
- License
- 04-008
- Legal business name
- AMERIGROUP NEW YORK, LLC
- Doing business as
- AMERIGROUP Community Care
- Practice address
- 360 W 31St St
5TH Floor
New York, NY 10001-2727 - Phone
- (212) 563-5570
- Fax
- (212) 563-5975
- NPI assigned
- Dec 1, 2005
- Last updated
- Jul 30, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Peter D. Haytaian
- Title
- President and Ceo
- Phone
- (212) 563-5570
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | 04-008 | NY | Primary |
Addresses
Primary practice location
360 W 31St St
5TH Floor
New York, NY 10001-2727
Mailing address
360 W 31St St
5TH Floor
New York, NY 10001-2727
Phone (212) 563-5570
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01617894 | Medicaid | NY | |
| 04-008 | Other | NY | DOH HMO NUMBER |
| 02644562 | Other | NY | MLTC PROVIDER ID |
Other names 1
- AMERIGROUP Community Care
National Provider Directory
National Provider DirectoryLocations
360 W 31st St
Fl 5
New York, NY 10001
Phone (212) 563-5570
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133395200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1185753600000",
"number": "1649254806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 W 31ST ST",
"address_2": "5TH FLOOR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100012727",
"telephone_number": "212-563-5570",
"fax_number": "212-563-5975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 W 31ST ST",
"address_2": "5TH FLOOR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100012727",
"telephone_number": "212-563-5570",
"fax_number": "212-563-5975"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AMERIGROUP NEW YORK, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-12-01",
"last_updated": "2007-07-30",
"status": "A",
"authorized_official_last_name": "HAYTAIAN",
"authorized_official_first_name": "PETER",
"authorized_official_middle_name": "D.",
"authorized_official_title_or_position": "PRESIDENT AND CEO",
"authorized_official_telephone_number": "212-563-5570",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "302R00000X",
"taxonomy_group": "",
"desc": "Health Maintenance Organization",
"state": "NY",
"license": "04-008",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01617894",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DOH HMO NUMBER",
"identifier": "04-008",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MLTC PROVIDER ID",
"identifier": "02644562",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "AMERIGROUP Community Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.