Individual provider Active NPI

Philip John Mika, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Schenectady, NY
National Provider Identifier
1811910425
Registry record updated Jan 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
115728 Issued in NY
Practice address
2125 River Rd
Suite 303
Schenectady, NY 12309-1135
Phone
(518) 382-8350
Fax
(518) 382-0345
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 115728 NY Primary

Addresses

Primary practice location

2125 River Rd
Suite 303
Schenectady, NY 12309-1135

Mailing address

2125 River Rd
Suite 303
Schenectady, NY 12309-1135
Phone (518) 382-8350

Other identifiers 11

IdentifierTypeStateIssuer
070119000062OtherNYFIDELIS - ENDOCRINOLOGY
4625730OtherNYAETNA
47346OtherNYGHI/HMO
28N081OtherNYEMPIRE BC
200097OtherNYSENIOR WHOLE HEALTH
000408519001OtherNYBSNENY
11120OtherNYMVP
28102OtherNYMVP
00527477MedicaidNY
041208000020OtherNYFIDELIS - INT MEDICINE
10001371OtherNYCDPHP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
115728NYMDSocial Worker
157281NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Physicians, PC Endocrinology, Diabetes & Metabolism PastSince Jan 1, 1998 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358985600000",
    "number": "1811910425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 RIVER RD",
            "address_2": "SUITE 303",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123091135",
            "telephone_number": "518-382-8350",
            "fax_number": "518-382-0345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 RIVER RD",
            "address_2": "SUITE 303",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123091135",
            "telephone_number": "518-382-8350",
            "fax_number": "518-382-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKA",
        "first_name": "PHILIP",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2013-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NY",
            "license": "115728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS - ENDOCRINOLOGY",
            "identifier": "070119000062",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4625730",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI/HMO",
            "identifier": "47346",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC",
            "identifier": "28N081",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENIOR WHOLE HEALTH",
            "identifier": "200097",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSNENY",
            "identifier": "000408519001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "11120",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "28102",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00527477",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS - INT MEDICINE",
            "identifier": "041208000020",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10001371",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schenectady, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.