NPIMap

Individual provider Active NPI

Mark A Shapiro, MD

  • Family Medicine Physician
  • Port Jefferson Station, NY
National Provider Identifier
1003914680
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
147508 Issued in NY
Practice address
10 B Medical Dr
Port Jefferson Station, NY 11776
Phone
(631) 474-1111
Fax
(631) 474-4694
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 147508 NY Primary

Addresses

Primary practice location

10 B Medical Dr
Port Jefferson Station, NY 11776

Mailing address

10 B Medical Dr
Port Jefferson Station, NY 11776
Phone (631) 474-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031208000965 NY Practitioner - Family Practice 4880599539 Practice locations: Port Jefferson Station, NY

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Carolina at Chapel Hill School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10 B Medical Dr
Port Jefferson Station, NY 11776-1590

10 Medical Dr
Suite B
Port Jefferson Station, NY 11776-1590
Phone (631) 474-1111

Hospital & facility affiliations

  • Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
  • Peconic Bay Homehealth Services Home health agency, Riverhead, NY, CCN 337400
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue79
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Vytaliz Medical CurrentSince Jan 6, 2021 Accepting new patients
PJS Medical Diagnostic PLLC CurrentSince Dec 16, 2020 Accepting new patients
Mendelsohn Medical, PLLC PastSince Dec 16, 2020 Accepting new patients

Locations

3 E Evergreen Rd
Ste 1017
New City, NY 10956
Phone (201) 565-2533

10 Medical Dr
Ste B
Port Jefferson Station, NY 11776
Phone (631) 474-1111

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DDCBAA/Endpoint/DDCBAA
  • Direct secure messaging: mark.shapiro@dmas.eclinicaldirectplus.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597363200000",
    "number": "1003914680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 B MEDICAL DR",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-474-1111",
            "fax_number": "631-474-2389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 B MEDICAL DR",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-474-1111",
            "fax_number": "631-474-4694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAPIRO",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "147508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.