NPIMap

Organization Active NPI

Poughkeepsie Medical Group LLP

  • Internal Medicine Physician
  • Poughkeepsie, NY
National Provider Identifier
1700979507
Registry record updated Jul 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
POUGHKEEPSIE MEDICAL GROUP LLP
Practice address
375 Hooker Ave.
Poughkeepsie, NY 12603
Phone
(845) 454-5000
Fax
(845) 454-9880
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2015

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

Authorized official

Name
Sumita Mazumdar, MDNPI 1265407266
Title
Billing Supervisior
Phone
(845) 454-5000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

375 Hooker Ave.
Poughkeepsie, NY 12603

Mailing address

375 Hooker Ave
Poughkeepsie, NY 12603
Phone (845) 454-5000

Other identifiers 1

IdentifierTypeStateIssuer
01076948MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060216000216 NY Part B Supplier - Clinic/Group Practice 5799676300 Receives reassigned benefits from 14 practitioners
Practice locations: Poughkeepsie, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0164296Poughkeepsie Medical Group375 Hooker Avenue, Poughkeepsie, NY 12603Certificate of waiverDec 31, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438041600000",
    "number": "1700979507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 HOOKER AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "12603",
            "telephone_number": "845-454-5000",
            "fax_number": "845-454-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 HOOKER AVE.",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "12603",
            "telephone_number": "845-454-5000",
            "fax_number": "845-454-9880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUGHKEEPSIE MEDICAL GROUP LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2015-07-28",
        "status": "A",
        "authorized_official_last_name": "MAZUMDAR",
        "authorized_official_first_name": "SUMITA",
        "authorized_official_title_or_position": "BILLING SUPERVISIOR",
        "authorized_official_telephone_number": "845-454-5000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01076948",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.