Active NPI
South Shore Family Medical Associates, P.C.
- Family Medicine Physician
- Inwood, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 205232
- Legal business name
- SOUTH SHORE FAMILY MEDICAL ASSOCIATES, P.C.
- Practice address
- 271 Doughty Blvd
Inwood, NY 11096-2135 - Phone
- (516) 371-6884
- Fax
- (516) 371-6083
- NPI assigned
- Feb 16, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Allan Scott Detweiler, D.O.
- Title
- President
- Phone
- (516) 371-6884
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 205232 | NY | Primary |
Addresses
Primary practice location
271 Doughty Blvd
Inwood, NY 11096-2135
Mailing address
271 Doughty Blvd
Inwood, NY 11096-2135
Phone (516) 371-6884
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01824973 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091117000286 | NY | Part B Supplier - Clinic/Group Practice | 5597803213 |
Receives reassigned benefits from 27 practitioners Practice locations: Arverne, NY; Baldwin, NY; Bronx, NY; Brooklyn, NY; Inwood, NY; Long Beach, NY; New York, NY; Rego Park, NY… |
National Provider Directory
National Provider DirectoryLocations
1797 Coney Island Ave
Fl 1
Brooklyn, NY 11230
50 Court St
Ste 1002
Brooklyn, NY 11201
Phone (212) 695-5122
342 Beach 54th St
Far Rockaway, NY 11692
Phone (718) 474-0801
229 W 36th St
Fl 10
New York, NY 10018
Phone (212) 695-5122
229 W 36th St
New York, NY 10018
Phone (212) 695-5122
229 W 36th St
#9
New York, NY 10018
787 W Merrick Rd
Valley Stream, NY 11580
Phone (516) 284-6253
Practitioners 41
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Island Park, NY
- NPI 1528254570
Family Medicine, NY
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D0960878 | South Shore Family Medical Assoc PC | Certificate of waiver | May 23, 2027 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1720122716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "271 DOUGHTY BLVD",
"city": "INWOOD",
"state": "NY",
"postal_code": "110962135",
"telephone_number": "516-371-6884",
"fax_number": "516-371-6083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "271 DOUGHTY BLVD",
"city": "INWOOD",
"state": "NY",
"postal_code": "110962135",
"telephone_number": "516-371-6884",
"fax_number": "516-371-6083"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTH SHORE FAMILY MEDICAL ASSOCIATES, P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-16",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "DETWEILER",
"authorized_official_first_name": "ALLAN",
"authorized_official_middle_name": "SCOTT",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "516-371-6884",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.O."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "NY",
"license": "205232",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01824973",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Inwood, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.