Alexander Peguero-Medrano, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

402196 Issued in NY

Practice address

169 Putnam Hall
Stony Brook, NY 11794-3240

Phone

(631) 632-9510

Fax

(631) 632-5870

NPI assigned

May 26, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Alexander Peguero-Medrano Other name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Stony Brook Psychiatric Associates University Faculty Practice CorporGroup PAC ID 7315836731, 101 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: alexander.peguero-medrano@direct.stonybrookmedicine.edu

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.

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  Medicare reassignment NPD Authorized official
• Stony Brook Psychiatric Associates, University Faculty Practice Corpor

  • Psychiatry Physician
  • Stony Brook, NY
  • NPI 1437105905
  Medicare reassignment Care Compare group NPD
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  Medicare reassignment NPD
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Stony Brook, NY
  • NPI 1972523348
  NPD

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

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672099200000",
    "number": "1033647623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900989",
            "telephone_number": "631-632-9510",
            "fax_number": "631-632-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 PUTNAM HALL",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117943240",
            "telephone_number": "631-632-9510",
            "fax_number": "631-632-5870"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "318 Jericho Tpke Apt 1",
            "address_purpose": "LOCATION",
            "city": "Floral Park",
            "state": "NY",
            "postal_code": "110012108",
            "country_code": "US",
            "telephone_number": "516-314-7056",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "430 Lakeville Rd",
            "address_purpose": "LOCATION",
            "city": "New Hyde Park",
            "state": "NY",
            "postal_code": "110421121",
            "country_code": "US",
            "telephone_number": "516-470-8910",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2590 Frisby Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104613240",
            "country_code": "US",
            "telephone_number": "718-239-1610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEGUERO-MEDRANO",
        "first_name": "ALEXANDER",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-26",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "402196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXANDER",
            "last_name": "PEGUERO-MEDRANO",
            "prefix": "MR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Psychiatric/Mental Health Nurse Practitioner in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2022; 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.

Verify at the official NPI Registry.