Individual provider Active NPI

Kevin Ramdeen, AGPCNP

  • Adult Health Nurse Practitioner
  • Stony Brook, NY
National Provider Identifier
1013780022
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
311538 Issued in NY
Practice address
101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone
(631) 312-6354
NPI assigned
Nov 1, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 311538 NY Primary

Addresses

Primary practice location

101 Nicolls Rd
Stony Brook, NY 11794-0001

Mailing address

40 Carston St
Selden, NY 11784-4024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240103000623 NY Practitioner - Nurse Practitioner 4385094309 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
311538NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Surgical Associates, University Faculty Practice Corporati CurrentSince Jan 15, 2024 Accepting new patients

Locations

101 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-2065

100 Nicolls Rd
Rm 60
Stony Brook, NY 11794
Phone (631) 444-7653

3 Edmund D Pellegrino Rd
Stony Brook, NY 11794
Phone (631) 638-0800

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1698796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1013780022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 CARSTON ST",
            "city": "SELDEN",
            "state": "NY",
            "postal_code": "117844024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-312-6354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAMDEEN",
        "first_name": "KEVIN",
        "credential": "AGPCNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-01",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "311538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.