Individual provider Active NPI

Anthony Greenidge

  • Family Medicine Physician
  • Jamaica, NY
National Provider Identifier
1679610471
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
211616 Issued in NY
Practice address
8900 Van Wyck Expy
Jamaica, NY 11418-2897
Phone
(718) 206-6290
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 211616 NY Primary

Addresses

Primary practice location

8900 Van Wyck Expy
Jamaica, NY 11418-2897

Mailing address

1276 Fulton Ave FL 3
Bronx, NY 10456-3402
Phone (917) 232-6319

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
I20040323001431 NY Practitioner - Family Practice 2062303514 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York Downstate Medical Center, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bronxcare Health SystemGroup PAC ID 3870404429, 335 clinicians

Practice addresses (Care Compare)

1276 Fulton Ave
Bronx, NY 10456-3402

1650 Grand Concourse
Bronx, NY 10457-7606

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
211616NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bronxcare Health System Family Medicine CurrentSince Nov 1, 2007 Accepting new patients
Bronxcare Health System CurrentSince Nov 1, 2007 Accepting new patients
Bronxcare Health System Family Medicine Current Accepting new patients
Startcare, Inc. Past Accepting new patients

Locations

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

1276 Fulton Ave
Fl 3
Bronx, NY 10456
Phone (718) 901-8236

1276 Fulton Ave
Rm 228
Bronx, NY 10456

Networks

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

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197936000000",
    "number": "1679610471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 FULTON AVE FL 3",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563402",
            "telephone_number": "917-232-6319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8900 VAN WYCK EXPY",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114182897",
            "telephone_number": "718-206-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENIDGE",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "211616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.