NPIMap

Organization Active NPI

Tri State Surgical Associates PLLC

  • Specialist
  • Middletown, NY
National Provider Identifier
1801993175
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
216778 Issued in NY
Legal business name
TRI STATE SURGICAL ASSOCIATES PLLC
Practice address
384 Crystal Run Rd
Suite 201
Middletown, NY 10941-4013
Phone
(845) 692-8780
Fax
(845) 692-3439
NPI assigned
Sep 20, 2006
Last updated
Nov 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Authorized official

Name
Gina Kowal
Title
Billing Manager
Phone
(845) 692-8780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 216778 NY Primary

Addresses

Primary practice location

384 Crystal Run Rd
Suite 201
Middletown, NY 10941-4013

Mailing address

384 Crystal Run Rd
Suite 201
Middletown, NY 10941-4013
Phone (845) 692-8780

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061213000619 NY Part B Supplier - Clinic/Group Practice 1254330509 Receives reassigned benefits from 7 practitioners
Practice locations: Fishkill, NY; Warwick, NY; Suffern, NY; Sleepy Hollow, NY; Newburgh, NY; Middletown, NY

National Provider Directory

National Provider Directory

Locations

200 Westage Business Ctr Dr
Ste 119
Fishkill, NY 12524
Phone (845) 896-0610

384 Crystal Run Rd
Ste 201
Middletown, NY 10941
Phone (845) 692-8780

777 N Broadway
Ste 207
Sleepy Hollow, NY 10591
Phone (845) 517-2870

156 Route 59
Ste A2
Suffern, NY 10901
Phone (845) 360-9553

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1801993175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "384 CRYSTAL RUN RD",
            "address_2": "SUITE 201",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109414013",
            "telephone_number": "845-692-8780",
            "fax_number": "845-692-3439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 CRYSTAL RUN RD",
            "address_2": "SUITE 201",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109414013",
            "telephone_number": "845-692-8780",
            "fax_number": "845-692-3439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE SURGICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "KOWAL",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "845-692-8780"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "216778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.