NPIMap

Organization Active NPI

Hillside Polymedic Diagnostic & Treatment Center Inc

  • Clinic/Center
  • Jamaica, NY
National Provider Identifier
1689879280
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
HILLSIDE POLYMEDIC DIAGNOSTIC & TREATMENT CENTER INC
Practice address
18730 Hillside Ave
Jamaica, NY 11432-3216
Phone
(718) 264-1111
NPI assigned
Jun 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

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

Authorized official

Name
Ms. Bridget Chime
Title
Administrator
Phone
(718) 264-1111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NY Primary

Addresses

Primary practice location

18730 Hillside Ave
Jamaica, NY 11432-3216

Mailing address

18730 Hillside Ave
Jamaica, NY 11432-3216
Phone (718) 264-1111

Other identifiers 1

IdentifierTypeStateIssuer
02903579MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141117000444 NY Part B Supplier - Clinic/Group Practice 5496977910 Receives reassigned benefits from 17 practitioners
Practice locations: Jamaica, NY

National Provider Directory

National Provider Directory

Locations

18730 Hillside Ave
Jamaica, NY 11432
Phone (718) 264-1111

Practitioners & affiliated clinicians

Practitioners 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676419200000",
    "number": "1689879280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18730 HILLSIDE AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114323216",
            "telephone_number": "718-264-1111",
            "fax_number": "718-264-9125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18730 HILLSIDE AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114323216",
            "telephone_number": "718-264-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLSIDE POLYMEDIC DIAGNOSTIC & TREATMENT CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A",
        "authorized_official_last_name": "CHIME",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "718-264-1111",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02903579",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; 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.