Organization Active NPI

Eastern Pain Medicine PC

  • Pain Medicine (Anesthesiology) Physician
  • Fishkill, NY
National Provider Identifier
1831475896
Registry record updated Mar 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
225874 Issued in NY
Legal business name
EASTERN PAIN MEDICINE PC
Practice address
1003 Main St
Fishkill, NY 12524-1786
Phone
(845) 471-0013
Fax
(845) 613-2493
NPI assigned
Oct 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2020

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

Authorized official

Name
Mrs. Vimala Upadhyayula
Title
Manager
Phone
(845) 471-0014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X 225874 NY Primary

Addresses

Primary practice location

1003 Main St
Fishkill, NY 12524-1786

Mailing address

1003 Main St
Fishkill, NY 12524-1786
Phone (845) 471-0013

Other identifiers 1

IdentifierTypeStateIssuer
03482024MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111129000052 NY Part B Supplier - Clinic/Group Practice 6406020619 Receives reassigned benefits from 1 practitioner
Practice locations: Kingston, NY; Fishkill, NY; Poughkeepsie, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2083303Eastern Pain Medicine PC1003 Main Street, Fishkill, NY 12524Certificate of waiverSep 2, 2026

National Provider Directory

National Provider Directory

Locations

1003 Main St
Fishkill, NY 12524
Phone (845) 291-3656

30 Reade Pl
Poughkeepsie, NY 12601
Phone (845) 214-1096

66 Middlebush Rd
Ste G101
Wappingers Falls, NY 12590
Phone (845) 471-0013

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585094400000",
    "number": "1831475896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 MAIN ST",
            "city": "FISHKILL",
            "state": "NY",
            "postal_code": "125241786",
            "telephone_number": "845-471-0013",
            "fax_number": "845-613-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 MAIN ST",
            "city": "FISHKILL",
            "state": "NY",
            "postal_code": "125241786",
            "telephone_number": "845-471-0013",
            "fax_number": "845-613-2493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN PAIN MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-21",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A",
        "authorized_official_last_name": "UPADHYAYULA",
        "authorized_official_first_name": "VIMALA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "845-471-0014",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NY",
            "license": "225874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03482024",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishkill, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.