NPIMap

Individual provider Active NPI

Emily T. Etzkorn, M.D.

  • Internal Medicine Physician
  • Amsterdam, NY
National Provider Identifier
1871554543
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2024171 Issued in NY
Practice address
5010 State Highway 30
Suite G-02
Amsterdam, NY 12010-7532
Phone
(518) 842-0017
Fax
(518) 842-7545
NPI assigned
Mar 31, 2006
Last updated
Feb 4, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2024171 NY Primary
Pediatrics Physician 208000000X 2024171 NY

Addresses

Primary practice location

5010 State Highway 30
Suite G-02
Amsterdam, NY 12010-7532

Mailing address

5010 State Highway 30
Suite G-02
Amsterdam, NY 12010-7532
Phone (518) 842-0017

Other identifiers 1

IdentifierTypeStateIssuer
02047565MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101026001392 NY Practitioner - Internal MedicinePractitioner - Pediatric Medicine 1850584541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Albany Medical College of Union University, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Emily T. Etzkorn, M.D., P.C.Group PAC ID 1557554235, 3 clinicians

Practice addresses (Care Compare)

5010 State Hwy 30
Suite G02
Amsterdam, NY 12010-7532
Phone (518) 842-0017

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2024171NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emily T. Etzkorn, M.D., P.C. Internal Medicine CurrentSince May 14, 2001 Accepting new patients
St. Mary's Healthcare PastSince Nov 1, 2011 Accepting new patients
St. Mary's Healthcare Past Accepting new patients
Emily T. Etzkorn, MD, PC Past Accepting new patients
St. Mary's Healthcare Past Accepting new patients

Locations

5010 State Highway 30
Ste G02
Amsterdam, NY 12010
Phone (518) 842-0017

Interoperability endpoints

  • Direct secure messaging: etzkorn01@eetzkorn.medentdirect.com

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St. Mary's HealthcareAmsterdam, NY, CCN 330047 Hospital Corporate Director Jul 1, 2007
St. Mary's HealthcareAmsterdam, NY, CCN 33S047 Hospital Corporate Director Jul 1, 2007
St. Mary's HealthcareAmsterdam, NY, CCN 33T047 Hospital Corporate Director Jan 1, 2024
St. Mary's HealthcareAmsterdam, NY, CCN 335857 Skilled nursing facility Corporate Director Dec 1, 2022

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265241600000",
    "number": "1871554543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5010 STATE HIGHWAY 30",
            "address_2": "SUITE G-02",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120107532",
            "telephone_number": "518-842-0017",
            "fax_number": "518-842-7545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5010 STATE HIGHWAY 30",
            "address_2": "SUITE G-02",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120107532",
            "telephone_number": "518-842-0017",
            "fax_number": "518-842-7545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETZKORN",
        "first_name": "EMILY",
        "middle_name": "T.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-31",
        "last_updated": "2010-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "2024171",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "2024171",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02047565",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amsterdam, NY

Sources for this page

Verify at the official NPI Registry.