Mercy Medical Center
Organization Active NPI Internal Medicine Physician · Rockville Centre, NY
NPI 1104097294 · NPPES record last updated Jan 21, 2020
Key facts
- NPI
- 1104097294
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 178140 (NY)
- Legal business name
- MERCY MEDICAL CENTER
- Practice address
- 1000 N. Village Avenue
Rockville Centre, NY 11571 - Phone
- (516) 705-1353
- Fax
- (516) 705-3575
- NPI assigned
- Mar 17, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- MERCY MEDICAL CENTER
Authorized official
- Name
- John Reilly, MD
- Title
- Chief Medical Officer
- Phone
- (516) 705-1353
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 4
Practitioners 309
-
Justin De'Prey, MD
-
Robert A Fishman, MD
-
Steven James Gangloff, M.D.
-
Danielle Haskins, M.D.
-
Bradley Marc Klein, M.D.
-
Cintasha T'Rena Redmond, M.D.
-
Darshana Pritesh Amin, D.O.
-
Kyle William Binder, M.D., PH.D.
-
Georgy Cherkassky, M.D.
-
Ellie Frazey, MD
-
Birenkumar Patel, M.D.
-
Colby Allen Richardson, M.D.
-
Chut Sombutmai, DO
-
Jason P Stabley, D.O.
-
Arvind Vasudevan, M.D.
-
Yelena Vidgop, MD
-
Jafreen Ahmed, MD
-
Guy Amir, PA-C
-
Jillian Bennett, PA-C
-
Eden Bessaleli, PA
-
Anil Bhagavath, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in NY, FL, NJ, NC, PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040210000431 | NY | Part B Supplier - Clinic/Group Practice | 4082518006 |
Receives reassigned benefits from 319 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bethpage, NY; Garden City, NY; Rockville Centre, NY; Smithtown, NY |
| O20250625002596 | FL | Part B Supplier - Clinic/Group Practice | 4082518006 |
Receives reassigned benefits from 7 practitioners Practice locations: Tampa, FL; Weston, FL; Vero Beach, FL; Stuart, FL; North Fort Myers, FL; Melbourne, FL; Ellenton, FL |
| O20250922003860 | NJ | Part B Supplier - Clinic/Group Practice | 4082518006 |
Receives reassigned benefits from 5 practitioners Practice locations: Cranbury, NJ; Freehold, NJ; Madison, NJ; Mahwah, NJ; Paramus, NJ |
| O20251003000178 | NC | Part B Supplier - Clinic/Group Practice | 4082518006 |
Receives reassigned benefits from 6 practitioners Practice locations: Asheville, NC; Concord, NC; Durham, NC; Holly Springs, NC; Raleigh, NC; Winston Salem, NC |
| O20251205001541 | PA | Part B Supplier - Clinic/Group Practice | 4082518006 |
Receives reassigned benefits from 2 practitioners Practice locations: Wexford, PA; Latrobe, PA |
National Provider Directory
- Part of
- Mercy Hosp-Pul Sys
Locations
385 Oak St
Garden City, NY 11530
Phone (516) 705-3400
41 Maine Ave
Rockville Ctr, NY 11570
Phone (516) 536-7730
526 Greengrove Ave
Uniondale, NY 11553
Phone (516) 977-2050
1220 Front St
Uniondale, NY 11553
Phone (516) 539-0518
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 178140 | NY | Yes |
Addresses
Primary practice location
1000 N. Village Avenue
Rockville Centre, NY 11571
Mailing address
P.O. Box 798
Rockville Centre, NY 11571
Phone (516) 705-1353
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02898020 | Medicaid | NY |
Other providers in Rockville Centre, NY
- Stephanie Vanessa Melo
- Memorial Sloan-Kettering Cancer Center at St Francis Mercy
- Sarah Mendez
- Mercy Dental LLC
- Mercy Internal Medicine PC
- Mercy Medical Center
- Mercy Medical Center
- Mercy Medical Center
- Mercy Medical Center
- Mercy Medical Center
All providers in Rockville Centre, NY · Internal Medicine 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 Jan 21, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.