NPIMap

Organization Active NPI

New York Institute of Technology

  • Family Medicine Physician
  • Jonesboro, AR
National Provider Identifier
1760003248
Registry record updated Jan 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NEW YORK INSTITUTE OF TECHNOLOGY
Practice address
333B Red Wolf Blvd
Jonesboro, AR 72405-9739
Phone
(870) 972-2054
Fax
(870) 972-2131
NPI assigned
May 6, 2020
Last updated
Jan 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
NEW YORK INSTITUTE OF TECHNOLOGYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2021

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

Authorized official

Name
Sharon K Zimmerman, MPA
Title
Assistant Dean
Phone
(516) 320-1466

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

333B Red Wolf Blvd
Jonesboro, AR 72405-9739

Mailing address

PO Box 119
State University, AR 72467-0119
Phone (516) 320-1466

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://arsujoapp.ecwcloud.com-2 Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201028002880 AR Part B Supplier - Clinic/Group Practice 3779496039 Receives reassigned benefits from 11 practitioners
Practice locations: Jonesboro, AR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Barbara Capozzi3 organizations share this tax ID, including this one
Part of
Barbara Capozzi

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

333 Red Wolf Blvd
#B
Jonesboro, AR 72405
Phone (870) 680-8809

333 Red Wolf Blvd
Ste B
Jonesboro, AR 72405
Phone (870) 933-2054

Practitioners & affiliated clinicians

Practitioners 70

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.

View all 70

NPI Registry JSON

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

{
    "created_epoch": "1588723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610064000000",
    "number": "1760003248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 119",
            "city": "STATE UNIVERSITY",
            "state": "AR",
            "postal_code": "724670119",
            "telephone_number": "516-320-1466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333B RED WOLF BLVD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724059739",
            "telephone_number": "870-972-2054",
            "fax_number": "870-972-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK INSTITUTE OF TECHNOLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEW YORK INSTITUTE OF TECHNOLOGY",
        "enumeration_date": "2020-05-06",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ASSISTANT DEAN",
        "authorized_official_telephone_number": "516-320-1466",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://arsujoapp.ecwcloud.com-2",
            "affiliation": "N",
            "endpointDescription": "Eclinicalworks",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "333B Red Wolf Blvd",
            "city": "Jonesboro",
            "state": "AR",
            "country_code": "US",
            "postal_code": "724059739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.