Individual provider Active NPI

David Kaufman, M.D.

  • Child & Adolescent Psychiatry Physician
  • Waterloo, NY
National Provider Identifier
1699787648
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
170570 Issued in NY
Practice address
31 Thurber Dr
Waterloo, NY 13165-1600
Phone
(315) 539-1980
Fax
(315) 539-1054
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 170570 NY Primary

Addresses

Primary practice location

31 Thurber Dr
Waterloo, NY 13165-1600

Mailing address

31 Thurber Dr
Waterloo, NY 13165-1600
Phone (315) 539-1980

Other identifiers 1

IdentifierTypeStateIssuer
170570MedicaidNY

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
I20050616000413 NY Practitioner - Psychiatry 1658315049 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
170570NYMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Health Network, Inc. CurrentSince Feb 1, 2012 Accepting new patients
Rochester General Hospital CurrentSince Feb 1, 2012 Accepting new patients
Rochester General Hospital Current Accepting new patients
Rochester General Hospital CurrentSince Feb 1, 2012 Accepting new patients

Locations

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

490 E Ridge Rd
Rochester, NY 14621
Phone (585) 922-2500

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.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699787648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 THURBER DR",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651600",
            "telephone_number": "315-539-1980",
            "fax_number": "315-539-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 THURBER DR",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651600",
            "telephone_number": "315-539-1980",
            "fax_number": "315-539-1054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUFMAN",
        "first_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "170570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170570",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, NY

Sources for this page

Verify at the official NPI Registry.