Benjamin Daesoon Acker, D.O.
Individual provider Active NPI Otolaryngology Physician · Port Jefferson Station, NY
NPI 1104057439 · NPPES record last updated Apr 2, 2019
Key facts
- NPI
- 1104057439
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- License
- 291557 (NY)
- Practice address
- 1500 Route 112 BLDG. 4 - 2ND Floor
Port Jefferson Station, NY 11776-8054 - Phone
- (631) 928-0188
- Fax
- (631) 928-0185
- NPI assigned
- Aug 4, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Otolaryngology
- Education
- Rutgers School of Dental Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- ENT and Allergy Associates LLP
Practice addresses (Care Compare)
1086 N Broadway
Suite 220
Yonkers, NY 10701-1112
Phone (914) 963-8588
1500 Route 112
BLDG 4
Port Jefferson Station, NY 11776-8055
Phone (631) 928-0188
Hospital & facility affiliations
- John T Mather Memorial Hospital of Port Jefferson
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.45 of 100
- Quality
- 89.91
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140821000120 | NJ | Practitioner - Otolaryngology | 7315165099 | Reassigns benefits to 1 organization |
| I20180305001621 | NY | Practitioner - Otolaryngology | 7315165099 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles (4 of 8)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| ENT and Allergy Associates LLP | Otolaryngology | Current |
Accepting new patients |
| Sovereign Medical Group, LLC | Current |
Accepting new patients | |
| Sovereign Medical Group LLC | Current |
Accepting new patients | |
| ENT and Allergy Associates of Pennsylvania PLLC | Otolaryngology | Past | Accepting new patients |
Locations
85 Harristown Rd
#2
Glen Rock, NJ 07452
Phone (201) 855-8301
680 Kinderkamack Rd
Ste 300
Oradell, NJ 07649
Phone (201) 881-7869
1 Degraw Ave
Teaneck, NJ 07666
Phone (201) 837-2174
1500 Route 112
Bldg 4
Port Jefferson Station, NY 11776
Phone (631) 574-8354
660 White Plains Rd
Fl 4
Tarrytown, NY 10591
Phone (914) 984-2546
1086 N Broadway
Ste 220
Yonkers, NY 10701
Phone (914) 279-9500
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- benjamin.acker@direct.entandallergy.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 291557 | NY | Yes |
Addresses
Primary practice location
1500 Route 112 BLDG. 4 - 2ND Floor
Port Jefferson Station, NY 11776-8054
Mailing address
660 White Plains Rd FL 4
Tarrytown, NY 10591-5139
Phone (914) 984-2546
Other providers in Port Jefferson Station, NY
- 11 Medical Drive Wellness PLLC
- 7 Sky Imaging LLC
- Tony Abraham
- Denise A Abselet
- Access Home Care, Inc.
- Dani Elizabeth Ackerman
- Dana Adamkiewicz
- Savannah Ahern
- Talal Ahmad
- Sophia Aidiniou
All providers in Port Jefferson Station, NY · Otolaryngology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.