NPIMap

Organization Active NPI

Penfield Psychiatry PC

  • Psychiatry Physician
  • Penfield, NY
National Provider Identifier
1649544115
Registry record updated Oct 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
164491 Issued in NY
Legal business name
PENFIELD PSYCHIATRY PC
Practice address
421 Penbrooke Dr
Suite 12 a
Penfield, NY 14526-2045
Phone
(585) 388-6000
Fax
(585) 388-6004
NPI assigned
Mar 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2012

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

Authorized official

Name
Dr. Robert A Stern, M.D.
Title
President
Phone
(585) 388-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 164491 NY Primary

Addresses

Primary practice location

421 Penbrooke Dr
Suite 12 a
Penfield, NY 14526-2045

Mailing address

421 Penbrooke Dr
Suite 12 a
Penfield, NY 14526-2045
Phone (585) 388-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121126000531 NY Part B Supplier - Clinic/Group Practice 2365693264 Receives reassigned benefits from 42 practitioners
Practice locations: Farmington, NY; Penfield, NY; Rochester, NY
O20260317001981 NJ Part B Supplier - Clinic/Group Practice 2365693264 Receives reassigned benefits from 8 practitioners
Practice locations: Ocean City, NJ

National Provider Directory

National Provider Directory

Locations

1160 Corporate Dr
Ste 400
Farmington, NY 14425
Phone (585) 487-1700

2060 Fairport Nine Mile Point Rd
Ste 400
Penfield, NY 14526
Phone (585) 388-6000

441 Penbrooke Dr
Ste 10
Penfield, NY 14526
Phone (585) 388-6000

2060 Fairport Nine Mile Point Rd
Penfield, NY 14526
Phone (585) 377-5810

421 Penbrooke Dr
Ste 12A
Penfield, NY 14526
Phone (585) 388-6000

Practitioners & affiliated clinicians

Practitioners 52

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

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1330560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1649544115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 PENBROOKE DR",
            "address_2": "SUITE 12 A",
            "city": "PENFIELD",
            "state": "NY",
            "postal_code": "145262045",
            "telephone_number": "585-388-6000",
            "fax_number": "585-388-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 PENBROOKE DR",
            "address_2": "SUITE 12 A",
            "city": "PENFIELD",
            "state": "NY",
            "postal_code": "145262045",
            "telephone_number": "585-388-6000",
            "fax_number": "585-388-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENFIELD PSYCHIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-01",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "585-388-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "164491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Penfield, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.