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KINGS PARK PRIMARY MEDICAL CARE PC
NPI 1073747689
Internal Medicine in Kings Park, NY

Active since May 11, 2009CLIA 33D0962852 · Waiver
65 INDIAN HEAD RD, SUITE 2, KINGS PARK, NY 11754(631) 269-0180(631) 269-0178 Get Directions Write a Review

NPPES record last updated: May 11, 2009. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kings Park Primary Medical Care Pc NPPES

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

KINGS PARK PRIMARY MEDICAL CARE PC (NPI 1073747689) is a healthcare organization registered as an internal medicine in Kings Park, New York and active in the NPI registry since May 2009. The organization holds a CLIA Waiver certificate valid through February 20, 2028 and lists Debra Pincus, President, as its authorized official.

NPPES Registry Identity

NPI1073747689
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameKINGS PARK PRIMARY MEDICAL CARE PC
Location Address65 INDIAN HEAD RD, SUITE 2Kings Park, NY 11754-3729
Mailing Address65 Indian Head Rd, Suite 2Kings Park, NY 11754-3729 · (631) 269-0180
Phone(631) 269-0180
Fax(631) 269-0178
Organization SubpartNo
Authorized OfficialDebra PincusPresident · (631) 269-0180
Enumeration DateMay 11, 2009
✔ NPI 1073747689 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in NY · 183029
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedPediatricsTaxonomy 208000000X · License 183029 (NY)
65 INDIAN HEAD RD, Kings Park, NY 11754
Open in Google Maps ↗

Other Identifiers 1

Medicare UPIN562081NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kings Park Primary Medical Care Pc 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 Kings Park Primary Medical Care PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Debra Pincus, MD
Internal Medicine
NPI 1548255102
65 INDIAN HEAD RD SUITE 2
Kings Park, NY 11754
(631) 269-0180
✔ PECOS✔ Accepts MedicareSame address

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 Waiver 33D0962852

Kings Park Primary Medical Care · Kings Park, NY
Active · expires Feb 20, 2028
CLIA Number33D0962852
Laboratory TypePhysician Office
Certificate Effective DateFebruary 21, 2026
Certificate Expiration DateFebruary 20, 2028
Laboratory DirectorDebra Pincus
Laboratory Phone(631) 269-0180
Laboratory LocationKings Park Primary Medical Care65 Indian Head Road, Kings Park, NY 11754
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Kings Park Primary Medical Care PC's NPI number?

The NPI number for Kings Park Primary Medical Care PC is 1073747689. It was assigned to this organization in the NPPES registry on May 11, 2009.

Where is Kings Park Primary Medical Care PC located?

Kings Park Primary Medical Care PC is located at 65 Indian Head Rd Suite 2, Kings Park, NY 11754. The listed phone number is (631) 269-0180.

What is Kings Park Primary Medical Care PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Kings Park Primary Medical Care PC enrolled in Medicare?

Yes. Kings Park Primary Medical Care PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Kings Park Primary Medical Care PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Kings Park Primary Medical Care PC. 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 Kings Park Primary Medical Care PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D0962852) is associated with this NPI, valid through February 20, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kings Park Primary Medical Care PC was last updated on May 11, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.