NPIMap

Organization Active NPI

CCN General Medicine PLLC

  • Primary Care Clinic/Center
  • Bronx, NY
National Provider Identifier
1902120025
Registry record updated Mar 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
255626 Issued in NY
Legal business name
CCN GENERAL MEDICINE PLLC
Practice address
1262 Boston Rd
Suite 2
Bronx, NY 10456-3602
Phone
(718) 569-7929
Fax
(347) 590-5482
NPI assigned
Mar 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2026

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

Authorized official

Name
Hector D Reyes, MBANPI 1740340397
Title
Adm
Phone
(718) 569-7929

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Primary Care Clinic/Center 261QP2300X 255626 NY Primary

Addresses

Primary practice location

1262 Boston Rd
Suite 2
Bronx, NY 10456-3602

Mailing address

1262 Boston Rd
Suite 2
Bronx, NY 10456-3602
Phone (718) 569-7929

Other identifiers 2

IdentifierTypeStateIssuer
02932589MedicaidNY
1427118140OtherNYNPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100331000407 NY Part B Supplier - Clinic/Group Practice 3577699339 Receives reassigned benefits from 16 practitioners
Practice locations: Bronx, 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
33D2009552CCN General Medicine PLLC1262 Boston Road Suite 2, Bronx, NY 10456Certificate of waiverJul 6, 2028

National Provider Directory

National Provider Directory

Locations

1262 Boston Rd
#2
Bronx, NY 10456
Phone (718) 569-7929

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JEJIAA

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774224000000",
    "number": "1902120025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1262 BOSTON RD",
            "address_2": "SUITE 2",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563602",
            "telephone_number": "718-569-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1262 BOSTON RD",
            "address_2": "SUITE 2",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563602",
            "telephone_number": "718-569-7929",
            "fax_number": "347-590-5482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCN GENERAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADM",
        "authorized_official_telephone_number": "718-569-7929",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "255626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02932589",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1427118140",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2026; 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.