NPIMap

Organization Active NPI

Ithaca Medical Group, PLLC

  • Internal Medicine Physician
  • Ithaca, NY
National Provider Identifier
1962561951
Registry record updated Oct 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ITHACA MEDICAL GROUP, PLLC
Practice address
1301 Trumansburg Rd
Suite P
Ithaca, NY 14850-1397
Phone
(607) 272-5414
Fax
(607) 272-6121
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2008

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

Authorized official

Name
Dr. Charles Labe Garbo, M.D.NPI 1942363346
Title
Owner
Phone
(607) 272-5414

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 1

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

Addresses

Primary practice location

1301 Trumansburg Rd
Suite P
Ithaca, NY 14850-1397

Mailing address

201 Harris B Dates Dr
Suite 102
Ithaca, NY 14850-1345
Phone (607) 272-5414

National Provider Directory

National Provider Directory

Locations

201 Harris B Dates Dr
Ste 102
Ithaca, NY 14850
Phone (607) 272-5414

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14564/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1962561951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 HARRIS B DATES DR",
            "address_2": "SUITE 102",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501345",
            "telephone_number": "607-272-5414",
            "fax_number": "607-272-6121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 TRUMANSBURG RD",
            "address_2": "SUITE P",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501397",
            "telephone_number": "607-272-5414",
            "fax_number": "607-272-6121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ITHACA MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "GARBO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "LABE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "607-272-5414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; 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.