Individual provider Active NPI

Jeffrey M King, M.D.

  • Otolaryngology Physician
  • Johnson City, NY
National Provider Identifier
1992795116
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
1939601 Issued in NY
Practice address
15 Riverside Dr
Johnson City, NY 13790-2742
Phone
(607) 770-9050
Fax
(607) 770-9091
NPI assigned
Oct 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 1939601 NY Primary

Addresses

Primary practice location

15 Riverside Dr
Johnson City, NY 13790-2742

Mailing address

15 Riverside Dr
Johnson City, NY 13790-2742
Phone (607) 770-9050

Other identifiers 1

IdentifierTypeStateIssuer
00608737MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Jeffrey.King@direct.lourdes.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080422000657 NY Practitioner - Otolaryngology 1658267828 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
State University of Ny Upstate Medical University, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Our Lady of Lourdes Memorial Hospital IncGroup PAC ID 1254237779, 249 clinicians

Practice addresses (Care Compare)

169 Riverside Dr
Suite 206
Binghamton, NY 13905-4246
Phone (607) 798-6701

Hospital & facility affiliations

  • Our Lady of Lourdes Memorial Hospital, Inc Hospital, Binghamton, NY, CCN 330011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1939601NYMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Twin Tier Pathology Associates, PC Current Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Jan 2, 2019 Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. Current Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Jan 2, 2019 Accepting new patients
Southern Tier Medical Care - Ny PC CurrentSince Sep 10, 2018 Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

15 Riverside Dr
Johnson City, NY 13790
Phone (607) 217-4170

Interoperability endpoints

  • Direct secure messaging: jking196865@direct-guthrie.org
  • Direct secure messaging: jeffrey.king@direct.lourdes.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1992795116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 RIVERSIDE DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902742",
            "telephone_number": "607-770-9050",
            "fax_number": "607-770-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 RIVERSIDE DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902742",
            "telephone_number": "607-770-9050",
            "fax_number": "607-770-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "JEFFREY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "1939601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00608737",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jeffrey.King@direct.lourdes.com",
            "affiliation": "N",
            "endpointDescription": "Lourdes Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "169 Riverside Dr",
            "city": "Binghamton",
            "state": "NY",
            "country_code": "US",
            "postal_code": "139054246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Johnson City, NY

Sources for this page

Verify at the official NPI Registry.