Organization Active NPI

Internal Medicine Associates of the Southern Tier, PC

  • Internal Medicine Physician
  • Elmira, NY
National Provider Identifier
1902902224
Registry record updated Mar 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE ASSOCIATES OF THE SOUTHERN TIER, PC
Practice address
200 Madison Ave
Elmira, NY 14901-3218
Phone
(607) 734-1581
Fax
(607) 767-4109
NPI assigned
Sep 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2013

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

Authorized official

Name
Christopher J Russo
Title
Director of Information Services
Phone
(607) 734-1581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

200 Madison Ave
Elmira, NY 14901-3218

Mailing address

200 Madison Ave
Elmira, NY 14901-3218
Phone (607) 734-1581

Other identifiers 1

IdentifierTypeStateIssuer
01770805MedicaidNY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1902902224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MADISON AVE",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013218",
            "telephone_number": "607-734-1581",
            "fax_number": "607-767-4109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MADISON AVE",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013218",
            "telephone_number": "607-734-1581",
            "fax_number": "607-767-4109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES OF THE SOUTHERN TIER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR OF INFORMATION SERVICES",
        "authorized_official_telephone_number": "607-734-1581"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01770805",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmira, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.