Sudeep Jabaraj Ross, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

297063 Issued in NY

Practice address

854 Route 212
Saugerties Wellness Center
Saugerties, NY 12477

Phone

(845) 246-2804

NPI assigned

May 14, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Oldendorf Medical Services, PLLC

  • Internal Medicine Physician
  • Loudonville, NY
  • NPI 1518107069
  Medicare reassignment NPD
• Samaritan Hospital of Troy, New York

  • General Acute Care Hospital
  • Troy, NY
  • NPI 1043267727

  Family Medicine

  Medicare reassignment NPD
• St. Peter'S Health Partners Medical Associates, P.C.

  • Multi-Specialty Clinic/Center
  • Albany, NY
  • NPI 1750626834

  Emergency Medicine

  Medicare reassignment NPD
• Tri-City Express Care, PLLC

  • Family Medicine Physician
  • Mesa, AZ
  • NPI 1649554940
  NPD (past)

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1821203589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "address_2": "SPHPMA CREDENTIALING",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "12212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "854 ROUTE 212",
            "address_2": "SAUGERTIES WELLNESS CENTER",
            "city": "SAUGERTIES",
            "state": "NY",
            "postal_code": "12477",
            "telephone_number": "845-246-2804"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Empire Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Rensselaer",
            "state": "NY",
            "postal_code": "121445730",
            "country_code": "US",
            "telephone_number": "518-373-4555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Tallow Wood Dr",
            "address_purpose": "LOCATION",
            "city": "Clifton Park",
            "state": "NY",
            "postal_code": "120652807",
            "country_code": "US",
            "telephone_number": "518-373-4444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "79 Vandenburgh Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121806024",
            "country_code": "US",
            "telephone_number": "518-286-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Patroon Creek Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122065013",
            "country_code": "US",
            "telephone_number": "518-445-4444",
            "fax_number": "518-618-1665",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "377 Church St",
            "address_purpose": "LOCATION",
            "city": "Saratoga Springs",
            "state": "NY",
            "postal_code": "128668641",
            "country_code": "US",
            "telephone_number": "518-584-4456",
            "fax_number": "518-584-4476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSS",
        "first_name": "SUDEEP",
        "middle_name": "JABARAJ",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "297063",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT187011",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "297063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05420228",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821203589",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Rios-Urrutia, LPN
• Toni Anne Riozzi, LPN
• Angel Rivera, NYS LMT
• Robert H Klein DDS PC
• Gregg Elwood Ross, RN
• Clare Rubin, PT
• Tammy Russell, LPN
• Abbie Sagastume
• Anna Nikolaevna Samedova, DO
• Maria Sanchez

• Family Medicine Physician in Saugerties, NY
• Providers in Saugerties, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.