NPIMap

Individual provider Active NPI

Gaetano Matthew Cristalli, D.O.

  • Family Medicine Physician
  • Rensselaer, NY
National Provider Identifier
1740593094
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
262096 Issued in NY
Practice address
279 Troy Rd
Family Medical Group
Rensselaer, NY 12144-9518
Phone
(518) 286-1922
NPI assigned
Jul 15, 2010
Last updated
May 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 262096 NY Primary

Addresses

Primary practice location

279 Troy Rd
Family Medical Group
Rensselaer, NY 12144-9518

Mailing address

PO Box 14890
Albany, NY 12212-4890
Phone (518) 525-5634

Other practice location 1

2215 Burdett Ave
Troy, NY 12180-2466
Phone (518) 271-3300

Other practice location 2

600 Northern Blvd
Albany, NY 12204-1004
Phone (518) 471-3221

Other identifiers 1

IdentifierTypeStateIssuer
00473565MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111026000274 NY Practitioner - Family Practice 8820261597 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2215 Burdett Ave
Troy, NY 12180-2466
Phone (518) 271-3554

279 Troy Rd
Rensselaer, NY 12144-9756
Phone (518) 286-1922

315 S Manning Blvd
Albany, NY 12208-1707

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Hospital of Troy, New York Family Medicine CurrentSince Apr 24, 2017 Accepting new patients
St. Peter's Hospital of the City of Albany Family Medicine CurrentSince Apr 1, 2013 Accepting new patients
St. Peter's Hospital of the City of Albany Family Medicine CurrentSince Apr 1, 2013 Accepting new patients
St. Peter's Hospital of the City of Albany Family Medicine Current Accepting new patients
Samaritan Hospital of Troy, New York Family Medicine Past Accepting new patients

Locations

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

600 Northern Blvd
Albany, NY 12204
Phone (518) 427-3331

279 Troy Rd
Rensselaer, NY 12144
Phone (518) 286-1922

2215 Burdett Ave
Troy, NY 12180
Phone (518) 271-3300

Interoperability endpoints

  • Direct secure messaging: gcristalli788961@direct.trinity-health.org
  • Direct secure messaging: payer.credentialing@sphp.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1279152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1740593094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890",
            "telephone_number": "518-525-5634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "279 TROY RD",
            "address_2": "FAMILY MEDICAL GROUP",
            "city": "RENSSELAER",
            "state": "NY",
            "postal_code": "121449518",
            "telephone_number": "518-286-1922"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2215 Burdett Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121802466",
            "country_code": "US",
            "telephone_number": "518-271-3300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Northern Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122041004",
            "country_code": "US",
            "telephone_number": "518-471-3221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRISTALLI",
        "first_name": "GAETANO",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-15",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "262096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473565",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP- Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2215 Burdett Ave",
            "city": "Troy",
            "state": "NY",
            "country_code": "US",
            "postal_code": "121802466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rensselaer, NY

Sources for this page

Verify at the official NPI Registry.