SOUTHERN TIER PEDIATRICS PRACTICE, P.C.
NPI 1710902200
Pediatrics - Adolescent Medicine in Jamestown, NY
NPI Status: Active since July 13, 2006
Contact Information
1684 FOOTE AVENUE EXT
JAMESTOWN, NY
ZIP 14701
Phone: (716) 661-9730
Fax: (716) 661-9732
- Organization
- Pediatrics
- Adolescent Medicine
- CLIA Number: 33D0972508
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-09-2026
About SOUTHERN TIER PEDIATRICS PRACTICE, P.C.
This page provides the complete NPI Profile along with additional information for Southern Tier Pediatrics Practice, P.c., a pediatrician established in Jamestown, New York operating as a Pediatrics, focusing in adolescent medicine . The healthcare provider is registered in the NPI registry with number 1710902200 assigned on July 2006. The practitioner's primary taxonomy code is 2080A0000X with license number 207469 (NY). The provider is registered as an organization and their NPI record was last updated 12 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Tariq M Khan M.d. (President)
- NPI
- 1710902200
- Provider Name
- SOUTHERN TIER PEDIATRICS PRACTICE, P.C.
- Entity Type
- Organization
- Location Address
- 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701
- Location Phone
- (716) 661-9730
- Location Fax
- (716) 661-9732
- Mailing Address
- 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701
- Mailing Phone
- (716) 661-9730
- Mailing Fax
- (716) 661-9732
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-13-2006
- Last Update Date
- 05-15-2013
- Code Navigator
A pediatrician like Southern Tier Pediatrics Practice, P.c. is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pediatrics Adolescent Medicine
- Taxonomy Code
- 2080A0000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 207469
- License State
- NY
- Taxonomy Description
- A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 02690682 | MEDICAID (05) | NY | |
| ========= | OTHER (01) | NY | FEDERAL TAX ID |
| 01664951 | MEDICAID (05) | NY |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 33D0972508
- Facility Type
- Physician Office
- Certificate Effective Date
- April 10, 2024
- Certificate Expiration Date
- April 09, 2026
- Laboratory Director
- DR. TARIQ M. KHAN
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Southern Tier Pediatrics Practice, P.c. to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for SOUTHERN TIER PEDIATRICS PRACTICE, P.C.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 7 | 1 | 0 | 9 | 0 | 2 | 2 | 0 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 2 | 0 | 18 | 0 | 4 | 2 | 0 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 2 + 0 + 1 + 8 + 0 + 4 + 2 + 0 + 24 = 50 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1710902200 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 10 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1881884526 | KATIE MARIE BELL RPA-C Individual | Physician Assistant | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
| 1336414796 | MS. LYNDSEY MARIE CARLSON RPA-C Individual | Physician Assistant | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
| 1861028623 | LEDA MARIE MARANGONI PA-C Individual | Physician Assistant | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
| 1891392122 | AMY JO CALDWELL FNP-C Individual | Nurse Practitioner | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
| 1922002906 | TARIQ MAHMOOD KHAN M.D. Individual | Pediatrics | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
| 1952765372 | JOANNA LINN OLSON PA Individual | Physician Assistant | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
| 1376114348 | MS. NATALIE ANN TORRES PA-C Individual | Physician Assistant | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
| 1669146809 | ELLEN JOANNE REED PA Individual | Physician Assistant | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
| 1134829229 | NERISSA RICH FNP-C Individual | Nurse Practitioner | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
| 1629045026 | MRS. AMY REBECCA BEACH CRNP Individual | Nurse Practitioner | 1684 FOOTE AVENUE EXT JAMESTOWN, NY 14701 (716) 661-9730 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1710902200, enumerated in the NPI registry as an "organization" on July 13, 2006
The provider is located at 1684 Foote Avenue Ext Jamestown, Ny 14701 and the phone number is (716) 661-9730
This medical organization specializes in Pediatrics with taxonomy code 2080A0000X with a focus in Adolescent Medicine
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 33D0972508 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on July 13, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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