1. Home
  2. Directory
  3. New York
  4. Brockport
  5. Internal Medicine
  6. NPI Profile

BROCKPORT VINE MEDICAL PC
NPI 1871144543
Internal Medicine in Brockport, NY

Active since September 24, 2019
122 WEST AVE STE 6, BROCKPORT, NY 14420(585) 208-8668 Get Directions Write a Review

NPPES record last updated: January 3, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jan 3, 2020, Oct 22, 2019, Sep 27, 2019 (3 updates tracked since 2019).

About Brockport Vine Medical Pc NPPES

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

BROCKPORT VINE MEDICAL PC (NPI 1871144543) is a healthcare organization registered as an internal medicine in Brockport, New York and active in the NPI registry since September 2019. The organization lists Alex Fahoury, Owner, as its authorized official.

NPPES Registry Identity

NPI1871144543
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameBROCKPORT VINE MEDICAL PC
Location Address122 WEST AVE STE 6Brockport, NY 14420-1225
Mailing Address67 Sarah CirSpencerport, NY 14559-9592 · (585) 208-8668 · Fax (585) 617-4219
Phone(585) 208-8668
Organization SubpartNo
Authorized OfficialAlex FahouryOwner · (585) 208-8668
Enumeration DateSeptember 24, 2019
Last NPPES UpdateJanuary 3, 20203 updates tracked since enumeration
✔ NPI 1871144543 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
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.
122 WEST AVE STE 6, Brockport, NY 14420
Open in Google Maps ↗

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 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)

Brockport Vine Medical Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Brockport Vine Medical PC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Alex Fahoury, MD
Internal Medicine
NPI 1467406934
122 WEST AVE STE 6B
Brockport, NY 14420
(585) 391-3040
✔ PECOSSame address
Brihanna Fitch, NP
Nurse Practitioner
NPI 1790576890
122 WEST AVE STE 6B
Brockport, NY 14420
(585) 391-3040
✔ PECOSSame address
Amber Seeler, FNP
Nurse Practitioner
NPI 1629644547
140 COBBLESTONE COURT DR
Victor, NY 14564
(585) 922-9280
✔ PECOS✔ Accepts Medicare29 mi
Diane Weezorak, NP
Nurse Practitioner
NPI 1083627210
411 COMMERCIAL CT STE C
Venice, FL 34292
(813) 333-5080
✔ PECOS1,138 mi

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 Brockport Vine Medical PC's NPI number?

The NPI number for Brockport Vine Medical PC is 1871144543. It was assigned to this organization in the NPPES registry on September 24, 2019.

Where is Brockport Vine Medical PC located?

Brockport Vine Medical PC is located at 122 West Ave Ste 6, Brockport, NY 14420. The listed phone number is (585) 208-8668.

What is Brockport Vine Medical PC's specialty?

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

Is Brockport Vine Medical PC enrolled in Medicare?

Yes. Brockport Vine Medical PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Brockport Vine Medical PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Brockport Vine Medical 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. The largest specialties are Nurse Practitioner (3) and Internal Medicine (1). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Brockport Vine Medical PC was last updated on January 3, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.