Individual provider Active NPI

Antonio Lam, DO

  • Student in an Organized Health Care Education/Training Program
  • Bronx, NY
National Provider Identifier
1780172965
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
111 E 210TH St
Bronx, NY 10467-2401
Phone
(718) 920-4154
NPI assigned
Apr 24, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

111 E 210TH St
Bronx, NY 10467-2401

Mailing address

759 Chestnut St
Springfield, MA 01199-1001
Phone (413) 794-0000

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
I20240924003638 NY Practitioner - General Surgery 4486901667 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Long Island Laparoscopic Surgery,P.L.L.CGroup PAC ID 9830523117, 6 clinicians

Practice addresses (Care Compare)

625 Belle Terre Rd
Suite 202
Port Jefferson, NY 11777-2318
Phone (631) 686-7982

Hospital & facility affiliations

  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Charles Hospital Corp CurrentSince Nov 1, 2025 Accepting new patients
Montefiore Medical Center CurrentSince Jul 12, 2024 Accepting new patients
Montefiore Medical Center CurrentSince Jul 12, 2024 Accepting new patients
Montefiore Medical Center Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678

Organizations & group practices 6

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": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1780172965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "759 CHESTNUT ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011991001",
            "telephone_number": "413-794-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-920-4154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAM",
        "first_name": "ANTONIO",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-24",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.