NPIMap

Individual provider Active NPI

Bernard Member, M.D.

  • Child & Adolescent Psychiatry Physician
  • Ithaca, NY
National Provider Identifier
1750526570
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
143064 Issued in NY
Practice address
103 W Seneca St
Suite 303C
Ithaca, NY 14850-4145
Phone
(804) 339-2105
NPI assigned
Dec 8, 2008
Last updated
Jan 5, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 143064 NY
Child & Adolescent Psychiatry Physician 2084P0804X 143064 NY Primary

Addresses

Primary practice location

103 W Seneca St
Suite 303C
Ithaca, NY 14850-4145

Mailing address

103 W Seneca St
Suite 303C
Ithaca, NY 14850-4145
Phone (804) 339-2105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
143064NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hanover County Board of Supervisors Past Accepting new patients
Mental Health Resources PC PastSince Nov 29, 2012 Accepting new patients
Hanover County Board of Supervisors Past Accepting new patients
Resource Guidance Services Inc Past Accepting new patients
Behavior & Stress Management Center Past Accepting new patients
MCV Associated Physicians Psychiatry Past Accepting new patients
Middle Peninsula-Northern Neck Mental Health and Mental Retardation Past Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1750526570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 W SENECA ST",
            "address_2": "SUITE 303C",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504145",
            "telephone_number": "804-339-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W SENECA ST",
            "address_2": "SUITE 303C",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148504145",
            "telephone_number": "804-339-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMBER",
        "first_name": "BERNARD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-08",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "143064",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "143064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.