Active NPI
Stephen George Donohue, R.N.
- Registered Nurse
- Lake Ronkonkoma, NY
National Provider Identifier
1013179720
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective Sep 20, 2012.
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 503326-1
- Practice address
- 186 Smith Rd
Lake Ronkonkoma, NY 11779-2212 - Phone
- (631) 258-0165
- NPI assigned
- Jun 25, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 503326-1 | NY | Primary |
Addresses
Primary practice location
186 Smith Rd
Lake Ronkonkoma, NY 11779-2212
Mailing address
186 Smith Rd
Lake Ronkonkoma, NY 11779-2212
Phone (631) 258-0165
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 503326-1 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 503326-1 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214352000000",
"number": "1013179720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "186 SMITH RD",
"city": "LAKE RONKONKOMA",
"state": "NY",
"postal_code": "117792212",
"telephone_number": "631-258-0165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "186 SMITH RD",
"city": "LAKE RONKONKOMA",
"state": "NY",
"postal_code": "117792212",
"telephone_number": "631-258-0165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONOHUE",
"first_name": "STEPHEN",
"middle_name": "GEORGE",
"credential": "R.N.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-25",
"last_updated": "2008-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "503326-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "503326-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Ronkonkoma, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.