Active NPI
Mark David Wasserman, MD
- Family Medicine Physician
- Miller Place, NY
National Provider Identifier
1033176805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 132521
- Practice address
- 555 Route 25a
Miller Place, NY 11764-2625 - Phone
- (631) 744-6666
- Fax
- (631) 744-0525
- NPI assigned
- Apr 27, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 132521 | NY | Primary |
Addresses
Primary practice location
555 Route 25a
Miller Place, NY 11764-2625
Mailing address
555 Route 25a
Miller Place, NY 11764-2625
Phone (631) 744-6666
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00651661 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050110000661 | NY | Practitioner - Family Practice | 2365490067 | Practice locations: Miller Place, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1974
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
555 Route 25a
Miller Place, NY 11764-2671
Phone (631) 744-6666
Hospital & facility affiliations
- Peconic Bay Homehealth Services
- Catholic Home Care
- John T Mather Memorial Hospital of Port Jefferson
- Suny/Stony Brook University Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 132521 | NY | MD | Family Medicine Physician |
Interoperability endpoints
- mark.wasserman.1@12747.direct.athenahealth.com
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Riverhead, NY
- NPI 1932155678
-
- General Acute Care Hospital
- Port Jefferson, NY
- NPI 1093718728
-
- Home Health Agency
- Farmingdale, NY
- NPI 1780670711
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1033224704
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1225507114
-
- General Acute Care Hospital
- Greenport, NY
- NPI 1881690691
-
- General Acute Care Hospital
- Stony Brook, NY
- NPI 1972523348
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204156800000",
"number": "1033176805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 ROUTE 25A",
"city": "MILLER PLACE",
"state": "NY",
"postal_code": "117642625",
"telephone_number": "631-744-6666",
"fax_number": "631-744-0525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 ROUTE 25A",
"city": "MILLER PLACE",
"state": "NY",
"postal_code": "117642625",
"telephone_number": "631-744-6666",
"fax_number": "631-744-0525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASSERMAN",
"first_name": "MARK",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2008-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "132521",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00651661",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miller Place, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.