CENTRAL PARK PHYSICAL MEDICINE PC
NPI 1174848501
Specialist in Laurelton, NY
About Central Park Physical Medicine Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CENTRAL PARK PHYSICAL MEDICINE PC (NPI 1174848501) is a healthcare organization registered as a specialist in Laurelton, New York and active in the NPI registry since March 2010. The organization lists Samuel Michael Theagene, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Central Park Physical Medicine 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 Central Park Physical Medicine PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Central Park Physical Medicine PC's NPI number?
The NPI number for Central Park Physical Medicine PC is 1174848501. It was assigned to this organization in the NPPES registry on March 29, 2010.
Where is Central Park Physical Medicine PC located?
Central Park Physical Medicine PC is located at 21714 Merrick Blvd, Laurelton, NY 11413. The listed phone number is (347) 270-8353.
What is Central Park Physical Medicine PC's specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Central Park Physical Medicine PC enrolled in Medicare?
Yes. Central Park Physical Medicine PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Central Park Physical Medicine PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Pain Management) reassigns their Medicare billing to Central Park Physical Medicine 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.
When was this NPI record last updated?
The NPPES record for Central Park Physical Medicine PC was last updated on March 30, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Central Park Physical Medicine Pc · NPI 1174848501
Specialist organization in Laurelton, New York. Organization record, active in the CMS NPPES registry since March 29, 2010.
## Identity
- **NPI:** 1174848501 (Entity type: Organization)
- **Enumerated:** March 29, 2010
- **Primary specialty:** Specialist · taxonomy 174400000X
- **Organization subpart:** No
- **Authorized official:** Samuel Theagene, OWNER
## Practice location
- **Address:** 21714 MERRICK BLVD, Laurelton, NY 11413-1917
- **Phone:** (347) 270-8353 · **Fax:** (347) 826-1917
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Pain Management) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 30, 2015
- **Other identifiers:** Other 194218-1 (NY)
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Source: [NPI Profile](https://npiprofile.com/npi/1174848501) · Data from the CMS NPPES public registry.