NPIMap

Individual provider Active NPI

Joseph Clerisme, MD

  • Psychiatry Physician
  • Queens Village, NY
National Provider Identifier
1790721710
Registry record updated May 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
154315 Issued in NY
Practice address
20922 Hillside Ave
Queens Village, NY 11427-1715
Phone
(718) 217-6279
Fax
(718) 217-6279
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 154315 NY Primary

Addresses

Primary practice location

20922 Hillside Ave
Queens Village, NY 11427-1715

Mailing address

20922 Hillside Ave
Queens Village, NY 11427-1715
Phone (718) 217-6279

Other identifiers 1

IdentifierTypeStateIssuer
00777142MedicaidNY

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
I20040629000611 NY Practitioner - Psychiatry 7416933445 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Medical Center 83 clinicians

Practice addresses (Care Compare)

1000 N Village Ave
Rockville Center, NY 11570-1000
Phone (516) 705-3428

20922 Hillside Ave
Queens Village, NY 11427-1715
Phone (718) 217-6279

Hospital & facility affiliations

  • Mercy Medical Center Hospital, Rockville Centre, NY, CCN 330259

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
154315NYMDPsychiatry Physician

Practice roles (13 of 17)

OrganizationSpecialtyStatusNew patients
St. Joseph Hospital CurrentSince Apr 16, 2019 Accepting new patients
St Charles Hospital Corp CurrentSince Mar 2, 2019 Accepting new patients
St. Catherine of Siena Medical Center CurrentSince Jul 20, 2019 Accepting new patients
Good Samaritan Hospital Medical Center Current Accepting new patients
Good Samaritan Hospital Medical CurrentSince Jul 20, 2019 Accepting new patients
Mercy Medical Center CurrentSince Nov 18, 2017 Accepting new patients
St. Francis Hospital CurrentSince Mar 2, 2019 Accepting new patients
St Francis Hospital United States Catholic Conference CurrentSince Mar 2, 2019 Accepting new patients
Mercy Medical Center CurrentSince Nov 18, 2017 Accepting new patients
St. Francis Hospital Current Accepting new patients
Mercy Medical Center Current Accepting new patients
Brookdale Hospital Medical Center Past Accepting new patients
Brookdale Hospital Medical Center Past Accepting new patients

Locations

4295 Hempstead Tpke
Bethpage, NY 11714
Phone (516) 520-2250

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

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

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

Interoperability endpoints

  • Direct secure messaging: jclerisme84266@direct-chsli.net

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 3

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242691200000",
    "number": "1790721710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20922 HILLSIDE AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114271715",
            "telephone_number": "718-217-6279",
            "fax_number": "718-217-6279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20922 HILLSIDE AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114271715",
            "telephone_number": "718-217-6279",
            "fax_number": "718-217-6279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLERISME",
        "first_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2009-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "154315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00777142",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Queens Village, NY

Sources for this page

Verify at the official NPI Registry.