NPIMap

Organization Active NPI

John T. Mather Memorial Hospital

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Port Jefferson, NY
National Provider Identifier
1073863635
Registry record updated Sep 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X
License
225349-1 Issued in NY
Legal business name
JOHN T. MATHER MEMORIAL HOSPITAL
Practice address
75 North Country Rd
Port Jefferson, NY 11777-2190
Phone
(631) 473-1320
NPI assigned
Sep 11, 2012
Last updated
Sep 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2012

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

Authorized official

Name
Mr. Joseph Wisnoski
Title
Cfo, VP- Finance
Phone
(631) 473-1320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X 225349-1 NY Primary

Addresses

Primary practice location

75 North Country Rd
Port Jefferson, NY 11777-2190

Mailing address

625 Belle Terre Road
Suite 100
Port Jefferson, NY 11777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130103000478 NY Part B Supplier - Hospital Department(S) 1254237753 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
Practice locations: Port Jefferson, NY

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
John Mather Mem Hos-STR T11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

100 Highlands Blvd
#9
Port Jefferson, NY 11777
Phone (631) 686-7809

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8502/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347321600000",
    "number": "1073863635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 BELLE TERRE ROAD",
            "address_2": "SUITE 100",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "11777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 NORTH COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772190",
            "telephone_number": "631-473-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T. MATHER MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-11",
        "last_updated": "2012-09-11",
        "status": "A",
        "authorized_official_last_name": "WISNOSKI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CFO, VP- FINANCE",
        "authorized_official_telephone_number": "631-473-1320",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "NY",
            "license": "225349-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; 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.