EVERETT ROY FORMAN M.D.
NPI 1528061967
General Practice in Latham, NY

Q: What is Everett Forman's NPI number?

The NPI number for Everett Forman is 1528061967. It was assigned to this individual provider in the NPPES registry on May 31, 2005.

Q: What is Everett Forman's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Everett Forman was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.

Active since May 31, 2005PECOS EnrolledAccepts Medicare Assignment

585 TROY SCHENECTADY RD, LATHAM, NY 12110(518) 785-6004(518) 785-1702 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Everett Roy Forman M.d. NPPES

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

EVERETT ROY FORMAN M.D. (NPI 1528061967) is an individual general practice provider in Latham, New York, licensed in New York (103928-1) and active in the NPI registry since May 2005. He is enrolled in Medicare PECOS, is affiliated with St Peter's Hospital, and is a graduate of Albany Medical College Of Union University (1968).

NPPES Registry Identity

NPI1528061967

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameEVERETT ROY FORMANCredential: M.D.

Location Address585 TROY SCHENECTADY RDLatham, NY 12110-2811

Mailing Address47 Sweet RdBallston Lake, NY 12019-1805 · (518) 785-6004 · Fax (518) 785-1702

Phone(518) 785-6004

Fax(518) 785-1702

Sole ProprietorNo

Medical School CMSAlbany Medical College Of Union UniversityGraduated 1968

Enumeration DateMay 31, 2005

Last NPPES UpdateJuly 8, 2007

✔ NPI 1528061967 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in NY · 103928-1

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

585 TROY SCHENECTADY RD, Latham, NY 12110

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Other Identifiers 6

Other01148Mvp

Other10000672Cdphp

Other49E991Empire Bcbs

Other000401336001Blue Shield Of Neny

Medicare ID-Type Unspecified55078A

Medicare UPIND02266NY

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Everett Roy Forman M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4486744562

PECOS Enrollment IDI20071212000701

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

164 services84 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

99 services63 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

13 services13 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Peter's Hospital

Acute Care Hospitals · Albany, NY

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number330057

Location315 South Manning BoulevardAlbany, NY 12208 · Albany County

Emergency services Birthing friendly

Ellis Hospital

Acute Care Hospitals · Schenectady, NY

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number330153

Location1101 Nott StreetSchenectady, NY 12308 · Schenectady County

Emergency services Birthing friendly

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553

DME-Other DME · category DE017N

2 suppliers19 claims22 services$215.40 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EVERETT FORMAN PC

General Practice

585 TROY SCHENECTADY RD
LATHAM, NY 12110

Albany County (518) 785-6004

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 Everett Forman's NPI number?

The NPI number for Everett Forman is 1528061967. It was assigned to this individual provider in the NPPES registry on May 31, 2005.

Where is Everett Forman located?

Everett Forman practices at 585 Troy Schenectady Rd, Latham, NY 12110. The listed phone number is (518) 785-6004.

What is Everett Forman's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Everett Forman enrolled in Medicare?

Yes. Everett Forman is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Everett Forman affiliated with any hospitals?

According to CMS data, Everett Forman is affiliated with St Peter's Hospital and Ellis Hospital.

When was this NPI record last updated?

The NPPES record for Everett Forman was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.