NPIMap

Individual provider Active NPI

Frederick Joseph Gandolfo, M.D.

  • Gastroenterology Physician
  • Huntington, NY
National Provider Identifier
1053550079
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
253535 Issued in NY
Practice address
205 E Main St Ste 1-4
Huntington, NY 11743-7931
Phone
(631) 350-6077
NPI assigned
Feb 14, 2009
Last updated
Feb 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 253535 NY Primary

Addresses

Primary practice location

205 E Main St Ste 1-4
Huntington, NY 11743-7931

Mailing address

13 Central St
Huntington, NY 11743-2680
Phone (631) 350-6077

Other practice location 1

195 E Main St
Huntington, NY 11743-2957
Phone (631) 350-6077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120703000484 NY Practitioner - Gastroenterology 5092970731 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
State University of New York at Stony Brook, School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Precision Digestive Care, PCGroup PAC ID 5092077990, 2 clinicians
St Charles Hospital CorpGroup PAC ID 6103733050, 62 clinicians
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

13 Central St
Huntington, NY 11743-2680
Phone (631) 350-6077

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 474-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy77
Upper gastrointestinal (GI) endoscopy for acid reflux130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
253535NYMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Apr 1, 2020 Accepting new patients
CHS Physician Partners, PC CurrentSince Oct 15, 2025 Accepting new patients
CHS Physician Partners, P.C CurrentSince Oct 15, 2025 Accepting new patients
Precision Digestive Care, PC Gastroenterology CurrentSince Mar 1, 2018 Accepting new patients
CHS Physician Partners, PC Current Accepting new patients
North Shore - Lij Medical PC CurrentSince Apr 1, 2020 Accepting new patients
St Charles Hospital Corp Past Accepting new patients

Locations

2112 Middle Country Rd
Centereach, NY 11720
Phone (631) 247-7463

195 E Main St
Huntington, NY 11743
Phone (631) 385-8677

205 E Main St
Ste 1-4
Huntington, NY 11743
Phone (631) 350-6077

300 Community Dr
Manhasset, NY 11030

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

Networks

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

Interoperability endpoints

  • Direct secure messaging: fgandolfo25302@direct-chsli.net
  • Direct secure messaging: frederick.gandolfo.1@17365.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/17365/brand/1/csg/1/fhir/r4

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1234569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1053550079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 CENTRAL ST",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117432680",
            "telephone_number": "631-350-6077",
            "fax_number": "631-271-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E MAIN ST STE 1-4",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117437931",
            "telephone_number": "631-350-6077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "195 E Main St",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "NY",
            "postal_code": "117432957",
            "country_code": "US",
            "telephone_number": "631-350-6077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GANDOLFO",
        "first_name": "FREDERICK",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-14",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "253535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, NY

Sources for this page

Verify at the official NPI Registry.