NPIMap

Individual provider Active NPI

Irene Diana Patrylo, M.D.

  • Rehabilitation Practitioner
  • Port Jefferson, NY
National Provider Identifier
1104092493
Registry record updated Jun 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation PractitionerTaxonomy code 225400000X
License
198926 Issued in NY
Practice address
200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone
(631) 474-6879
Fax
(631) 474-6448
NPI assigned
May 6, 2008
Last updated
Jun 26, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Practitioner 225400000X 198926 NY Primary

Addresses

Primary practice location

200 Belle Terre Rd
Port Jefferson, NY 11777-1928

Mailing address

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 474-6879

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
I20080812000745 NY Practitioner - Physical Medicine and Rehabilitation 6002981958 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Physician Partners, P.C CurrentSince Apr 1, 2016 Accepting new patients
CHS Physician Partners, PC Current Accepting new patients
St Charles Hospital Corp CurrentSince Sep 27, 2009 Accepting new patients
St Charles Hospital Corp Past Accepting new patients

Locations

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

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

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

Networks

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

Interoperability endpoints

  • Direct secure messaging: ipatrylo36503@direct-chsli.net

Organizations & group practices 4

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 9

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": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245974400000",
    "number": "1104092493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771928",
            "telephone_number": "631-474-6879",
            "fax_number": "631-474-6448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771928",
            "telephone_number": "631-474-6879",
            "fax_number": "631-474-6448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRYLO",
        "first_name": "IRENE",
        "middle_name": "DIANA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-06",
        "last_updated": "2009-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "NY",
            "license": "198926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.