Individual provider Active NPI

Oren Ambalu, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Lake Katrine, NY
National Provider Identifier
1649618026
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
292454 Issued in NY
Practice address
1561 Route 9W
Lake Katrine, NY 12449-5410
Phone
(845) 231-5600
NPI assigned
Jun 7, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 25MA1004800 NJ
Pain Medicine (Anesthesiology) Physician 207LP2900X 292454 NY Primary

Addresses

Primary practice location

1561 Route 9W
Lake Katrine, NY 12449-5410

Mailing address

125 Paterson St Ste 3100
New Brunswick, NJ 08901-1962
Phone (732) 235-7827

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180509001169 NY Practitioner - Anesthesiology 7810268943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
New York Medical College, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians

Practice addresses (Care Compare)

1561 Route 9W
Lake Katrine, NY 12449-5410
Phone (845) 231-5600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA1004800NJMDAnesthesiology Physician
292454NYMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince May 7, 2018 Accepting new patients
Optum Medical Care, P.C. CurrentSince May 7, 2018 Accepting new patients
Mount Kisco Medical Group Past Accepting new patients

Locations

3680 Hill Blvd
Jefferson Valley, NY 10535
Phone (914) 245-7700

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

2507 South Rd
Poughkeepsie, NY 12601
Phone (845) 471-2287

Philadelphia, PA 19195

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: oambalu143451@direct.optum.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533600000000",
    "number": "1649618026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 PATERSON ST STE 3100",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011962",
            "telephone_number": "732-235-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1561 ROUTE 9W",
            "city": "LAKE KATRINE",
            "state": "NY",
            "postal_code": "124495410",
            "telephone_number": "845-231-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBALU",
        "first_name": "OREN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-07",
        "last_updated": "2018-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NJ",
            "license": "25MA1004800",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NY",
            "license": "292454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Katrine, NY

Sources for this page

Verify at the official NPI Registry.