Individual provider Active NPI

Thomas Sal Bottiglieri, D.O.

  • Sports Medicine (Family Medicine) Physician
  • Englewood, NJ
National Provider Identifier
1669496469
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
237430 Issued in NY
Practice address
500 Grand Ave Ste 101
Englewood, NJ 07631-4968
Phone
(201) 569-4445
Fax
(212) 304-7050
NPI assigned
Jul 26, 2006
Last updated
Mar 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 25MB07982100 NJ
Sports Medicine (Family Medicine) Physician 207QS0010X 237430 NY Primary

Addresses

Primary practice location

500 Grand Ave Ste 101
Englewood, NJ 07631-4968

Mailing address

622 W 168TH St PH 111130
New York, NY 10032-3720
Phone (212) 305-9137

Other practice location 1

622 W 168th St Ph 111130
New York, NY 10032-3720
Phone (212) 305-9137

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)
FHIR URL https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/ Health Information Exchange (HIE)
Direct Messaging Address thb9034@direct.nyp.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090612000497 NJ Practitioner - Family PracticePractitioner - Osteopathic Manipulative MedicinePractitioner - Sports MedicinePractitioner - Other (Physician) 7214087212 Reassigns benefits to 2 organizations
I20130926000204 NY Practitioner - Family PracticePractitioner - Sports Medicine 7214087212 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Rowan University School of Osteopathic Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairway Physical Therapy LLCGroup PAC ID 3971563222, 85 clinicians

Practice addresses (Care Compare)

500 Grand Ave
Suite 1
Englewood, NJ 07631-4968
Phone (212) 342-8586

7100 Fairway Dr
Palm Beach Gardens, FL 33418-3778
Phone (561) 775-7775

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
85.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Columbiadoctors of Bergen County CurrentSince Feb 1, 2016 Accepting new patients
Columbia Doctors of New Jersey, P. C. CurrentSince Jun 21, 2020 Accepting new patients
Columbia Doctors of New Jersey, P. C. CurrentSince Jun 21, 2020 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Sep 1, 2017 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Sep 1, 2017 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Aug 1, 2018 Accepting new patients
Prohealth Care Associates LLP Past Accepting new patients
The Trustees of Columbia University in the City of New York PastSince Dec 13, 2016 Accepting new patients

Locations

500 Grand Ave
Englewood, NJ 07631
Phone (201) 541-0440

500 Grand Ave
Fl 1
Englewood, NJ 07631
Phone (201) 227-1760

500 Grand Ave
Ste 101
Englewood, NJ 07631
Phone (201) 569-0010

223 N Van Dien Ave
Ridgewood, NJ 07450
Phone (201) 447-8417

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

3959 Broadway
Fl 8
New York, NY 10032
Phone (212) 305-1125

51 W 51st St
Ste 370
New York, NY 10019
Phone (631) 254-5577

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

622 W 168th St
Ph 11
New York, NY 10032
Phone (212) 305-5976

622 W 168th St
Ph 111130
New York, NY 10032
Phone (212) 305-0762

Networks

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

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1669496469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST PH 111130",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-9137",
            "fax_number": "212-304-7050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 GRAND AVE STE 101",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314968",
            "telephone_number": "201-569-4445",
            "fax_number": "212-304-7050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "622 W 168th St Ph 111130",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323720",
            "country_code": "US",
            "telephone_number": "212-305-9137",
            "fax_number": "212-304-7050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOTTIGLIERI",
        "first_name": "THOMAS",
        "middle_name": "SAL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NJ",
            "license": "25MB07982100",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NY",
            "license": "237430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "622 W 168th St Ph 11",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "FHIR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "622 W 168th St Ph 11",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "thb9034@direct.nyp.org",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Address",
            "address_1": "622 W 168th St Ph 11",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100323720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Englewood, NJ

Sources for this page

Verify at the official NPI Registry.