Individual provider Active NPI

Victor N Otvertchenko, M.D.

  • Anesthesiology Physician
  • Poughkeepsie, NY
National Provider Identifier
1720086234
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
215447 Issued in NY
Practice address
241 North Rd
Poughkeepsie, NY 12601-1154
Phone
(845) 483-5989
Fax
(845) 483-5912
NPI assigned
Jul 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 215447 NY Primary

Addresses

Primary practice location

241 North Rd
Poughkeepsie, NY 12601-1154

Mailing address

19 Bradhurst Ave Ste 3100N
Hawthorne, NY 10532-2140
Phone (914) 909-9018

Other practice location 1

1 Webster Ave
Suite 505
Poughkeepsie, NY 12601-1361
Phone (845) 452-0555

Other practice location 2

105 Marys Ave
Kingston, NY 12401-5829
Phone (845) 338-2500

Other practice location 3

396 Broadway
Kingston, NY 12401-4626
Phone (845) 483-5989

Other practice location 4

42084 State Highway 28
Margaretville, NY 12455-2820
Phone (845) 586-2631

Other identifiers 1

IdentifierTypeStateIssuer
02106187MedicaidNY

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
I20080129000201 NY Practitioner - Anesthesiology 7416968748 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Woods Rd
Valhalla, NY 10595-1530
Phone (914) 909-9018

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
215447NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Dec 1, 2016 Accepting new patients
Optum Medical Care, P.C. CurrentSince Dec 1, 2016 Accepting new patients
Montefiore Medical Center Anesthesiology CurrentSince Nov 3, 2021 Accepting new patients
Westchester Medical Center Advanced Physician Services PC Anesthesiology CurrentSince May 18, 2020 Accepting new patients
Premier Anesthesia of New York, P.C. Anesthesiology CurrentSince Dec 12, 2022 Accepting new patients
Westchester Medical Center Advanced Physician Services, PC Anesthesiology CurrentSince May 18, 2020 Accepting new patients
Montefiore Medical Center CurrentSince Nov 3, 2021 Accepting new patients
Anesthesia Associates of Rochester, P.C. Anesthesiology CurrentSince Dec 13, 2023 Accepting new patients
Anesthesia Associates of St. Francis, P.C Past Accepting new patients
Eastern Pain Medicine PC Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

529 Central Ave
Dunkirk, NY 14048
Phone (716) 338-9797

19 Bradhurst Ave
Ste 3100N
Hawthorne, NY 10532
Phone (914) 231-8373

105 Marys Ave
Kingston, NY 12401
Phone (845) 334-3080

396 Broadway
Kingston, NY 12401
Phone (845) 331-3131

42084 State Highway 28
Margaretville, NY 12455
Phone (845) 334-2819

34 S Bedford Rd
#P
Mount Kisco, NY 10549
Phone (914) 244-6789

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

34 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 244-6787

110 S Bedford Rd
#P
Mount Kisco, NY 10549

111 Driving Park Ave
Newark, NY 14513
Phone (315) 332-2022

23 Davis Ave
Poughkeepsie, NY 12603
Phone (845) 454-1025

1 Webster Ave
Ste 505
Poughkeepsie, NY 12601
Phone (845) 452-0333

241 North Rd
Poughkeepsie, NY 12601
Phone (845) 431-8889

130 Allens Creek Rd
Ste 200
Rochester, NY 14618
Phone (585) 410-6545

1500 N James St
Rome, NY 13440
Phone (315) 338-7000

2233 State Route 86
Saranac Lake, NY 12983
Phone (518) 891-4141

95 Grasslands Rd
Valhalla, NY 10595
Phone (914) 493-2961

100 Woods Rd
Valhalla, NY 10595
Phone (914) 490-7000

Philadelphia, PA 19195

Networks

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

Organizations & group practices 10

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 2

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": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1720086234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BRADHURST AVE STE 3100N",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105322140",
            "telephone_number": "914-909-9018",
            "fax_number": "914-909-9028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 NORTH RD",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011154",
            "telephone_number": "845-483-5989",
            "fax_number": "845-483-5912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Webster Ave",
            "address_2": "Suite 505",
            "address_purpose": "LOCATION",
            "city": "Poughkeepsie",
            "state": "NY",
            "postal_code": "126011361",
            "country_code": "US",
            "telephone_number": "845-452-0555",
            "fax_number": "845-452-0550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 Marys Ave",
            "address_purpose": "LOCATION",
            "city": "Kingston",
            "state": "NY",
            "postal_code": "124015829",
            "country_code": "US",
            "telephone_number": "845-338-2500",
            "fax_number": "845-331-2530",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "396 Broadway",
            "address_purpose": "LOCATION",
            "city": "Kingston",
            "state": "NY",
            "postal_code": "124014626",
            "country_code": "US",
            "telephone_number": "845-483-5989",
            "fax_number": "845-483-5912",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "42084 State Highway 28",
            "address_purpose": "LOCATION",
            "city": "Margaretville",
            "state": "NY",
            "postal_code": "124552820",
            "country_code": "US",
            "telephone_number": "845-586-2631",
            "fax_number": "845-586-1638",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTVERTCHENKO",
        "first_name": "VICTOR",
        "middle_name": "N",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "215447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02106187",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

Verify at the official NPI Registry.