NPIMap

Organization Active NPI

Olive Tree Medical Associates PLLC

  • Family Medicine Physician
  • Clinton, NY
National Provider Identifier
1851762173
Registry record updated Oct 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
253515 Issued in NY
Legal business name
OLIVE TREE MEDICAL ASSOCIATES PLLC
Practice address
7505 Foote Rd
Clinton, NY 13323-3403
Phone
(315) 269-4063
Fax
(315) 338-5407
NPI assigned
Oct 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2015

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

Authorized official

Name
Brian Chase, MDNPI 1881847598
Title
Owner
Phone
(315) 269-4063

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)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 253515 NY Primary

Addresses

Primary practice location

7505 Foote Rd
Clinton, NY 13323-3403

Mailing address

7505 Foote Rd
Clinton, NY 13323-3403
Phone (315) 269-4063

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151210001045 NY Part B Supplier - Clinic/Group Practice 3072814383 Receives reassigned benefits from 6 practitioners
Practice locations: Clinton, NY; New Hartford, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1444694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1851762173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7505 FOOTE RD",
            "city": "CLINTON",
            "state": "NY",
            "postal_code": "133233403",
            "telephone_number": "315-269-4063",
            "fax_number": "315-338-5407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7505 FOOTE RD",
            "city": "CLINTON",
            "state": "NY",
            "postal_code": "133233403",
            "telephone_number": "315-269-4063",
            "fax_number": "315-338-5407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE TREE MEDICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-13",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "CHASE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-269-4063",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "253515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; 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.