NPIMap

Organization Active NPI

Carondelet Regional Medical, PC

  • General Practice Physician
  • Broadalbin, NY
National Provider Identifier
1861939944
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CARONDELET REGIONAL MEDICAL, PC
Practice address
3768 State Highway 30
Broadalbin Health Center
Broadalbin, NY 12025-0923
Phone
(518) 883-3121
Fax
(518) 883-8268
NPI assigned
Jan 26, 2017
Last updated
May 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2023

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

Authorized official

Name
Ronald N Marsh, M.D.
Title
President
Phone
(518) 843-6914

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

3768 State Highway 30
Broadalbin Health Center
Broadalbin, NY 12025-0923

Mailing address

427 Guy Park Ave
Amsterdam, NY 12010-1064
Phone (518) 841-7401

Other practice location 1

119 Holland Circle Dr
Amsterdam, NY 12010-7550
Phone (518) 843-6914

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180515002257 NY Part B Supplier - Clinic/Group Practice 0840554051 Receives reassigned benefits from 50 practitioners
Practice locations: Amsterdam, NY

National Provider Directory

National Provider Directory

Locations

119 Holland Circle Dr
Unit C
Amsterdam, NY 12010
Phone (518) 843-6914

442 Guy Park Ave
Amsterdam, NY 12010
Phone (518) 842-0321

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 51

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.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1861939944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 GUY PARK AVE",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120101064",
            "telephone_number": "518-841-7401",
            "fax_number": "518-841-7404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3768 STATE HIGHWAY 30",
            "address_2": "BROADALBIN HEALTH CENTER",
            "city": "BROADALBIN",
            "state": "NY",
            "postal_code": "120250923",
            "telephone_number": "518-883-3121",
            "fax_number": "518-883-8268"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119 Holland Circle Dr",
            "address_purpose": "LOCATION",
            "city": "Amsterdam",
            "state": "NY",
            "postal_code": "120107550",
            "country_code": "US",
            "telephone_number": "518-843-6914",
            "fax_number": "518-843-6915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CARONDELET REGIONAL MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-26",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "MARSH",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-843-6914",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broadalbin, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.