NPIMap

Individual provider Active NPI

Brandon Michael Lundgren

  • Medical Physician Assistant
  • Saratoga Springs, NY
National Provider Identifier
1790040798
Registry record updated Jul 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
015656-1 Issued in NY
Practice address
211 Church St
Saratoga Springs, NY 12866
Phone
(518) 587-1141
NPI assigned
Jul 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 015656-1 NY Primary

Addresses

Primary practice location

211 Church St
Saratoga Springs, NY 12866

Mailing address

211 Church St
Saratoga Springs, NY 12866-1090
Phone (518) 587-1141

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
I20140117000877 NY Practitioner - Physician Assistant 2264660356 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saratoga HospitalGroup PAC ID 6406740273, 353 clinicians

Practice addresses (Care Compare)

1 W Ave
Suite 300
Saratoga Springs, NY 12866-6050
Phone (518) 693-4699

211 Church St
Saratoga Springs, NY 12866-1003
Phone (518) 583-8421

3040 Route 50
Saratoga Springs, NY 12866-3073
Phone (518) 580-2273

3044 Route 50
Saratoga Springs, NY 12866-3073
Phone (518) 886-5800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
68.51 of 100Reported as group
Quality
56.19
Improvement activities
40
Cost
75.36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
015656NYMDMental Health Counselor
015656-1NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Saratoga Hospital CurrentSince Jul 1, 2018 Accepting new patients
Saratoga Hospital CurrentSince Jul 1, 2018 Accepting new patients

Locations

211 Church St
Saratoga Springs, NY 12866
Phone (518) 583-8461

1 West Ave
Ste 300
Saratoga Springs, NY 12866
Phone (518) 693-4699

3044 Route 50
Saratoga Springs, NY 12866
Phone (518) 886-5800

6 Care Ln
Saratoga Springs, NY 12866
Phone (518) 581-1415

Interoperability endpoints

  • Direct secure messaging: blundgren99421@albanymed.direct-ci.com

Organizations & group practices 4

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 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530748800000",
    "number": "1790040798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 CHURCH ST",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "128661090",
            "telephone_number": "518-587-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 CHURCH ST",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "12866",
            "telephone_number": "518-587-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDGREN",
        "first_name": "BRANDON",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-06",
        "last_updated": "2018-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "015656-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saratoga Springs, NY

Sources for this page

Verify at the official NPI Registry.