Basic Information
| Provider Information | |||||||||
| NPI: | 1033212907 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BARNES PRIMARY CARE ASSOCIATES, P.C. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 113 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SILVER CREEK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141361452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169344518 | ||||||||
| FaxNumber: | 7169347443 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SILVER CREEK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141361452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169344518 | ||||||||
| FaxNumber: | 7169347443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 02/18/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BARNES | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7169344518 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00628208 | 05 | NY | MEDICAID | CB7494 | 01 | NY | RAILROAD MEDICARE | OTHER | CC5854 | 01 | NY | RAILROAD MEDICARE | OTHER |