Northway SPC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

4552201R Issued in NY

Legal business name

NORTHWAY SPC LLC

Practice address

1596 Route 9
Halfmoon, NY 12065

Phone

(518) 322-7720

NPI assigned

Jun 16, 2015

Organization subpart

No

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

Authorized official

Name

Kasandra A. Hopkins, RN, MSN

Title

Administrator

Phone

(518) 371-6772

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Listed as

Northway SPC LLCCCN 33C0001159

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 1

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

• Charles Fox Gordon III, MD

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  • NPI 1649243890
  NPD

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1992186852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1596 ROUTE 9",
            "city": "HALFMOON",
            "state": "NY",
            "postal_code": "120654303",
            "telephone_number": "518-371-6772",
            "fax_number": "518-288-2835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1596 ROUTE 9",
            "city": "HALFMOON",
            "state": "NY",
            "postal_code": "12065",
            "telephone_number": "518-322-7720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWAY SPC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-16",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "HOPKINS",
        "authorized_official_first_name": "KASANDRA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "518-371-6772",
        "authorized_official_credential": "RN, MSN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NY",
            "license": "4552201R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nicole M O'Brien Nurse Practitioner in Family Health PLLC
• John J Noonan, DC
• Nicole Alexandra Novondo, LP
• Michael Francis O'Brien, PA-C
• Nicole Marie O'Brien, DNP, FNP
• Melissa Orenstein, MS CCC-SLP
• Orthony Physical Therapy

• Ambulatory Surgical Clinic/Center in Halfmoon, NY
• Providers in Halfmoon, NY by specialty
• Ambulatory Surgical Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; 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.