MEDICARE: NORTHERN MEDICAL GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RG0100X	Gastroenterology Physician
2	208000000X	Pediatrics Physician
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
4	207RP1001X	Pulmonary Disease Physician
5	207L00000X	Anesthesiology Physician
6	207Q00000X	Family Medicine Physician
7	213E00000X	Podiatrist
8	208600000X	Surgery Physician
9	207RX0202X	Medical Oncology Physician
10	207RC0000X	Cardiovascular Disease Physician
11	207RR0500X	Rheumatology Physician
12	207RN0300X	Nephrology Physician
13	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174994826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	111 CLOCK TOWER CMNS
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4055
Country	:	US
Telephone Number	:	845-279-5187
Fax Number	:	855-703-7570

Provider Business Practice Location Address
First Line	:	111 CLOCK TOWER CMNS
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4055
Country	:	US
Telephone Number	:	845-279-5187
Fax Number	:	855-703-7570

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	CHRISTINE M BUSHEY
Credential	:
Telephone Number	:	845-592-4915

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	05/13/2026

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111 CLOCK TOWER CMNS , NORTHERN MEDICAL GROUP, PLLC
BREWSTER, NY
10509-4055

Practice Phone: 845-592-4915
Practice Fax: 845-592-4914

Directions to “NORTHERN MEDICAL GROUP, PLLC ” Practice Location

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