Individual provider Active NPI

John C Welch Jr., D.O.

  • Family Medicine Physician
  • Vestal, NY
National Provider Identifier
1750510848
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
258543 Issued in NY
Practice address
105 Ridgehaven Dr
Vestal, NY 13850-2640
Phone
(607) 786-4822
Fax
(607) 786-3837
NPI assigned
Jul 9, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 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 258543 NY Primary

Addresses

Primary practice location

105 Ridgehaven Dr
Vestal, NY 13850-2640

Mailing address

105 Ridgehaven Dr
Vestal, NY 13850-2640
Phone (607) 786-4822

Other identifiers 1

IdentifierTypeStateIssuer
03457710MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address john.welch@direct.lourdes.com Direct

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
I20120712000564 NY Practitioner - Family Practice 6204091408 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

169 Riveride Dr
Binghamton, NY 13905-4246

276 -280 Robinson St
Binghamton, NY 13904-1659
Phone (607) 722-2769

500 5TH Ave
Owego, NY 13827-1620
Phone (607) 687-1122

Hospital & facility affiliations

  • Lourdes at Home Chha Home health agency, Vestal, NY, CCN 337415
  • Our Lady of Lourdes Memorial Hospital, Inc Hospital, Binghamton, NY, CCN 330011

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
258543NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Twin Tier Pathology Associates, PC Current Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. Family Medicine CurrentSince Jul 1, 2012 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Jul 1, 2012 Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. Current Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

303 Main St
Binghamton, NY 13905
Phone (607) 729-8687

276-280 Robinson St
Binghamton, NY 13904
Phone (607) 722-2769

500 5th Ave
Owego, NY 13827
Phone (607) 687-1122

105 Ridgehaven Dr
Vestal, NY 13850
Phone (607) 786-4822

Interoperability endpoints

  • Direct secure messaging: jwelch196817@direct-guthrie.org

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 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": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1750510848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 RIDGEHAVEN DR",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138502640",
            "telephone_number": "607-786-4822",
            "fax_number": "607-786-3837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 RIDGEHAVEN DR",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138502640",
            "telephone_number": "607-786-4822",
            "fax_number": "607-786-3837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELCH",
        "first_name": "JOHN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-09",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "258543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03457710",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.welch@direct.lourdes.com",
            "affiliation": "N",
            "endpointDescription": "Lourdes Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "303 Main St",
            "city": "Binghamton",
            "state": "NY",
            "country_code": "US",
            "postal_code": "139052579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Vestal, NY

Sources for this page

Verify at the official NPI Registry.