NPIMap

Organization Active NPI

Mid Island Medical Associates, PLLC

  • Internal Medicine Physician
  • Center Moriches, NY
National Provider Identifier
1023905247
Registry record updated Aug 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MID ISLAND MEDICAL ASSOCIATES, PLLC
Practice address
172 Belleview Ave
Center Moriches, NY 11934-3731
Phone
(516) 697-8387
Fax
(516) 365-1476
NPI assigned
Jun 20, 2025
Last updated
Aug 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2025

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

Authorized official

Name
Dr. Olaf Butchma, DONPI 1326037474
Title
President
Phone
(203) 901-2493

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

172 Belleview Ave
Center Moriches, NY 11934-3731

Mailing address

PO Box 367
Manhasset, NY 11030-0367
Phone (516) 697-8387

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250826004536 NY Part B Supplier - Clinic/Group Practice 0345740965 Receives reassigned benefits from 12 practitioners
Practice locations: Brooklyn, NY; Westhampton, NY; West Islip, NY; West Babylon, NY; Middle Island, NY; Holtsville, NY; Hempstead, NY; Flushing, NY…

National Provider Directory

National Provider Directory

Locations

111 Beach Dr
West Islip, NY 11795
Phone (631) 587-1600

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1750377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755734400000",
    "number": "1023905247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 367",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110300367",
            "telephone_number": "516-697-8387",
            "fax_number": "516-365-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 BELLEVIEW AVE",
            "city": "CENTER MORICHES",
            "state": "NY",
            "postal_code": "119343731",
            "telephone_number": "516-697-8387",
            "fax_number": "516-365-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID ISLAND MEDICAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-20",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A",
        "authorized_official_last_name": "BUTCHMA",
        "authorized_official_first_name": "OLAF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-901-2493",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Center Moriches, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.