PRIDE MEDICAL, PLLC
NPI 1922214600
Clinic/Center - Primary Care in New York, NY
About Pride Medical, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PRIDE MEDICAL, PLLC (NPI 1922214600) is a healthcare organization registered as a primary care in New York, New York and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through June 5, 2027 and lists Punyadech Photangtham, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 3
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Pride Medical, Pllc 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 Pride Medical, PLLC, 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.
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 33D1069476
Pride Medical PLLC · New York, NYFrequently 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 Pride Medical, PLLC's NPI number?
The NPI number for Pride Medical, PLLC is 1922214600. It was assigned to this organization in the NPPES registry on May 16, 2007.
Where is Pride Medical, PLLC located?
Pride Medical, PLLC is located at 3875 Broadway Unit B, New York, NY 10032. The listed phone number is (917) 656-2951.
What is Pride Medical, PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Pride Medical, PLLC enrolled in Medicare?
Yes. Pride Medical, PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Pride Medical, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Pride Medical, PLLC. 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 Pride Medical, PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 33D1069476) is associated with this NPI, valid through June 5, 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 Pride Medical, PLLC was last updated on November 23, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.
# Pride Medical, Pllc · NPI 1922214600
Primary Care organization in New York, New York. Organization record, active in the CMS NPPES registry since May 16, 2007.
## Identity
- **NPI:** 1922214600 (Entity type: Organization)
- **Enumerated:** May 16, 2007
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Punyadech Photangtham, OWNER
## Practice location
- **Address:** 3875 BROADWAY, UNIT B, New York, NY 10032-1567
- **Phone:** (917) 656-2951
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 23, 2015
- **Other identifiers:** Other 1083700926 (NY); Medicare UPIN G99235 (NY); Medicare ID-Type Unspecified 11V951 (NY)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1922214600) · Data from the CMS NPPES public registry.