Active NPI
Peninsula Medical Care PLLC
- Urgent Care Clinic/Center
- Rockaway Park, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urgent Care Clinic/Center
- License
- 214772
- Legal business name
- PENINSULA MEDICAL CARE PLLC
- Practice address
- 115 - 06 Beach Channel Dr
Suite 1
Rockaway Park, NY 11694-2206 - Phone
- (718) 954-2202
- Fax
- (718) 351-6848
- NPI assigned
- Feb 3, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sadhana Gupta, MD
- Title
- Medical Director
- Phone
- (718) 954-2202
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | 214772 | NY | Primary |
Addresses
Primary practice location
115 - 06 Beach Channel Dr
Suite 1
Rockaway Park, NY 11694-2206
Mailing address
11506 Beach Channel Dr
Suite 1
Rockaway Park, NY 11694-2206
Phone (718) 954-2202
Other names 1
- bayview urgent care
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120314000241 | NY | Part B Supplier - Clinic/Group Practice | 5698934446 |
Receives reassigned benefits from 8 practitioners Practice locations: Staten Island, NY; Rockaway Park, NY |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2040630 | Peninsula Medical Care, PLLC | Certificate of waiver | May 6, 2028 |
National Provider Directory
National Provider DirectoryLocations
11506 Beach Channel Dr
Ste 1
Rockaway Park, NY 11694
Phone (718) 474-7744
11506 Beach Channel Dr
Ste 101
Rockaway Park, NY 11694
Phone (718) 474-7744
Practitioners & affiliated clinicians
Practitioners 9
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Rockaway Park, NY
- NPI 1285490268
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328227200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1611878400000",
"number": "1851663926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11506 BEACH CHANNEL DR",
"address_2": "SUITE 1",
"city": "ROCKAWAY PARK",
"state": "NY",
"postal_code": "116942206",
"telephone_number": "718-954-2202",
"fax_number": "718-351-6848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 - 06 BEACH CHANNEL DR",
"address_2": "SUITE 1",
"city": "ROCKAWAY PARK",
"state": "NY",
"postal_code": "116942206",
"telephone_number": "718-954-2202",
"fax_number": "718-351-6848"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PENINSULA MEDICAL CARE PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2012-02-03",
"last_updated": "2021-01-29",
"certification_date": "2021-01-29",
"status": "A",
"authorized_official_last_name": "GUPTA",
"authorized_official_first_name": "SADHANA",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "718-954-2202",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": "NY",
"license": "214772",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "bayview urgent care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Rockaway Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2021; 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.