NPIMap

Organization Active NPI

Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Glens Falls, NY
National Provider Identifier
1972558179
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
CONIFER PARK, INC.
Practice address
55 Elm St
Glens Falls, NY 12801-3549
Phone
(518) 793-7273
Fax
(518) 798-5004
NPI assigned
May 24, 2006
Last updated
Apr 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Authorized official

Name
Ms. Tammy Smith
Title
Dir, Op Billing Dept
Phone
(518) 952-8408

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

55 Elm St
Glens Falls, NY 12801-3549

Mailing address

PO Box 10092
Albany, NY 12201-5092
Phone (518) 952-8408

Other identifiers 1

IdentifierTypeStateIssuer
01420800MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040503001584 NY Part B Supplier - Clinic/Group Practice 2769470384 Receives reassigned benefits from 20 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Troy, NY; Schenectady, NY; Rochester, NY; Liverpool, NY; Glenville, NY; Glens Falls, NY; Plattsburgh, NY

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
33D2028443Conifer Park - Glens Falls Opc55 Elm Street, Glens Falls, NY 12801Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Conifer Park Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619654400000",
    "number": "1972558179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10092",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122015092",
            "telephone_number": "518-952-8408",
            "fax_number": "518-399-6860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 ELM ST",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128013549",
            "telephone_number": "518-793-7273",
            "fax_number": "518-798-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONIFER PARK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "DIR, OP BILLING DEPT",
        "authorized_official_telephone_number": "518-952-8408",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01420800",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glens Falls, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; 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.