NPIMap

Organization Active NPI

Lattimore Primary Care Medicine, PLLC

  • Internal Medicine Physician
  • Rochester, NY
National Provider Identifier
1730421272
Registry record updated Mar 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
161925 Issued in NY
Legal business name
LATTIMORE PRIMARY CARE MEDICINE, PLLC
Practice address
560 White Spruce Blvd
Rochester, NY 14623-1613
Phone
(585) 271-5250
Fax
(585) 271-0129
NPI assigned
Mar 22, 2013
Last updated
Mar 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2013

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

Authorized official

Name
Dr. Russell P Maggio, MDNPI 1518932441
Title
Owner
Phone
(585) 271-5250

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)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 161925 NY Primary

Addresses

Primary practice location

560 White Spruce Blvd
Rochester, NY 14623-1613

Mailing address

560 White Spruce Blvd
Rochester, NY 14623-1613
Phone (585) 271-5250

Other identifiers 2

IdentifierTypeStateIssuer
MD198COtherNYMVP
1392OtherNYEXCELLUS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131008001542 NY Part B Supplier - Clinic/Group Practice 6800020793 Receives reassigned benefits from 9 practitioners
Practice locations: Rochester, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1363910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363910400000",
    "number": "1730421272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 WHITE SPRUCE BLVD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146231613",
            "telephone_number": "585-271-5250",
            "fax_number": "585-271-0129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 WHITE SPRUCE BLVD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146231613",
            "telephone_number": "585-271-5250",
            "fax_number": "585-271-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LATTIMORE PRIMARY CARE MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-22",
        "last_updated": "2013-03-22",
        "status": "A",
        "authorized_official_last_name": "MAGGIO",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "585-271-5250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "161925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "MD198C",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS",
            "identifier": "1392",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; 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.