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PGR GASTRO LLC
NPI 1073106639
Pathology - Anatomic Pathology & Clinical Pathology in Valley Stream, NY

Active since February 15, 2021CLIA 33D2177176 · Certificate of Compliance
774 DUMONT PL, VALLEY STREAM, NY 11581(718) 979-9790(718) 979-9798 Get Directions Write a Review

NPPES record last updated: July 25, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 25, 2023, Feb 15, 2021 (2 updates tracked since 2021).

About Pgr Gastro Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PGR GASTRO LLC (NPI 1073106639) is a healthcare organization registered as an anatomic pathology & clinical pathology in Valley Stream, New York and active in the NPI registry since February 2021. The organization holds a CLIA Certificate of Compliance certificate valid through March 26, 2027 and lists Ross Brown, Credentialing Ex, as its authorized official.

NPPES Registry Identity

NPI1073106639
Entity TypeOrganization
Primary Taxonomy207ZP0102X
Legal Business NamePGR GASTRO LLC
Location Address774 DUMONT PLValley Stream, NY 11581-3122
Mailing Address457 Alter AveStaten Island, NY 10305-2310 · (718) 979-9790 · Fax (718) 979-9798
Phone(718) 979-9790
Fax(718) 979-9798
Organization SubpartNo
Authorized OfficialRoss BrownCredentialing Ex · (718) 313-0438
Enumeration DateFebruary 15, 2021
Last NPPES UpdateJuly 25, 20232 updates tracked since enumeration
NPPES CertifiedJuly 25, 2023
✔ NPI 1073106639 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPathology · Anatomic Pathology & Clinical PathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ZP0102X
Definition
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
Also ListedClinic/Center · EndoscopyTaxonomy 261QE0800X
774 DUMONT PL, Valley Stream, NY 11581
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Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pgr Gastro Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Pgr Gastro LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Pretam Rampersaud, MD
Gastroenterology
NPI 1104816685
705 86TH ST
Brooklyn, NY 11228
(718) 980-9898
✔ PECOS16 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 33D2177176

Pgr Gastro, LLC · Staten Island, NY
Active · expires Mar 26, 2027
CLIA Number33D2177176
Laboratory TypePhysician Office
Certificate Effective DateJanuary 7, 2020
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorImrana M. Ali
Laboratory Phone(718) 979-9790
Laboratory LocationPgr Gastro, LLC457 Alter Avenue, Staten Island, NY 10305
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pgr Gastro LLC's NPI number?

The NPI number for Pgr Gastro LLC is 1073106639. It was assigned to this organization in the NPPES registry on February 15, 2021.

Where is Pgr Gastro LLC located?

Pgr Gastro LLC is located at 774 Dumont Pl, Valley Stream, NY 11581. The listed phone number is (718) 979-9790.

What is Pgr Gastro LLC's specialty?

The primary specialty registered for this NPI is Pathology, specializing in Anatomic Pathology & Clinical Pathology, with taxonomy code 207ZP0102X.

Is Pgr Gastro LLC enrolled in Medicare?

Yes. Pgr Gastro LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pgr Gastro LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Gastroenterology) reassigns their Medicare billing to Pgr Gastro LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Pgr Gastro LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 33D2177176) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pgr Gastro LLC was last updated on July 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.