NPIMap

Individual provider Active NPI

Vivica Vollmer, M.D.

  • Family Medicine Physician
  • East Setauket, NY
National Provider Identifier
1073558995
Registry record updated Apr 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
207859 Issued in NY
Practice address
181 N Belle Mead Rd
East Setauket, NY 11733-3495
Phone
(631) 444-5858
Fax
(631) 444-1899
NPI assigned
Jun 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 207859 NY Primary

Addresses

Primary practice location

181 N Belle Mead Rd
East Setauket, NY 11733-3495

Mailing address

PO Box 1559
Stony Brook, NY 11790-0989
Phone (631) 444-2058

Other identifiers 3

IdentifierTypeStateIssuer
01766958MedicaidNY
5699593OtherNYAETNA
41X963OtherNYEMPIRE BC.BS

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
I20040710000217 NY Practitioner - Family Practice 5092793638 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Jefferson Medical College of Thomas Jefferson University, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5858

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5858

Hospital & facility affiliations

  • Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
  • Tender Loving Care, an Amedisys Company Home health agency, Medford, NY, CCN 337260
  • Centerwell Home Health Home health agency, Hauppauge, NY, CCN 337232
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
207859NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Family and Preventive Medicine, University Faculty Practic Family Medicine CurrentSince Oct 1, 1984 Accepting new patients

Locations

181 N Belle Mead Rd
Setauket, NY 11733
Phone (631) 444-0624

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Networks

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

Interoperability endpoints

  • Direct secure messaging: vivica.vollmer@direct.stonybrookmedicine.edu

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.

Hospital & facility affiliations 10

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": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651276800000",
    "number": "1073558995",
    "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": "631-444-2058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 N BELLE MEAD RD",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333495",
            "telephone_number": "631-444-5858",
            "fax_number": "631-444-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOLLMER",
        "first_name": "VIVICA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2022-04-30",
        "certification_date": "2022-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "207859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01766958",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5699593",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC.BS",
            "identifier": "41X963",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

Verify at the official NPI Registry.