NPIMap

Organization Active NPI

Northeast Medical Group, PLLC

  • Internal Medicine Physician
  • Greenwich, CT
National Provider Identifier
1942526207
Registry record updated Jan 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NORTHEAST MEDICAL GROUP, PLLC
Practice address
5 Perryridge Rd
Greenwich, CT 06830-4608
Phone
(203) 384-3975
NPI assigned
Apr 12, 2010
Last updated
Jan 10, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHEAST MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 10, 2018

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

Authorized official

Name
Beata Bialczak
Title
Manager
Phone
(203) 384-3975

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NY
Internal Medicine Physician 207R00000X NU Primary
Adolescent Medicine (Internal Medicine) Physician 207RA0000X NU
Gastroenterology Physician 207RG0100X NU
Obstetrics & Gynecology Physician 207V00000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

5 Perryridge Rd
Greenwich, CT 06830-4608

Mailing address

PO Box 415126
Boston, MA 02241-5126
Phone (203) 384-3975

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120313000116 NY Part B Supplier - Clinic/Group Practice 6204095201 Receives reassigned benefits from 48 practitioners
Practice locations: New Rochelle, NY; Rye Brook, NY; Rye, NY; Fishers Island, NY; Purchase, NY

National Provider Directory

National Provider Directory
Part of
Cardiac Specialists

Locations

1165 King St
Greenwich, CT 06831
Phone (203) 531-1335

20 York St
#329
New Haven, CT 06510
Phone (203) 688-1734

145 Hugenot St
Ste 215
Boston, MA 02241

5 Perryridge Rd
Boston, MA 02241

145 Huguenot St
Ste 125
New Rochelle, NY 10801

145 Huguenot St
Ste 215
New Rochelle, NY 10801
Phone (914) 235-6060

145 Huguenot St
Ste 610
New Rochelle, NY 10801
Phone (914) 235-1888

90 S Ridge St
Ste UL-2
Port Chester, NY 10573

3010 Westchester Ave
Ste 400
Purchase, NY 10577
Phone (914) 235-6060

26 Rye Ridge Plz
Rye Brook, NY 10573
Phone (914) 251-1100

115 Main St
Ste 300
Tuckahoe, NY 10707
Phone (914) 620-0511

Practitioners & affiliated clinicians

Practitioners 102

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 102

NPI Registry JSON

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

{
    "created_epoch": "1271030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515542400000",
    "number": "1942526207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415126",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415126",
            "telephone_number": "203-384-3975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PERRYRIDGE RD",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068304608",
            "telephone_number": "203-384-3975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MEDICAL GROUP, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST MEDICAL GROUP, INC.",
        "enumeration_date": "2010-04-12",
        "last_updated": "2018-01-10",
        "status": "A",
        "authorized_official_last_name": "BIALCZAK",
        "authorized_official_first_name": "BEATA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "203-384-3975"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwich, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2018; 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.