NPIMap

Organization Active NPI

Mercy Medical Center

  • Internal Medicine Physician
  • Rockville Centre, NY
National Provider Identifier
1104097294
Registry record updated Jan 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
178140 Issued in 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
Last updated
Jan 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2020

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

Authorized official

Name
John Reilly, MDNPI 1952453797
Title
Chief Medical Officer
Phone
(516) 705-1353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 178140 NY Primary

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 1

IdentifierTypeStateIssuer
02898020MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, FL, NJ, NC, PA5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Mercy Hosp-Pul Sys

Locations

90 Mill Rd
Freeport, NY 11520
Phone (516) 632-7980

1000 N Village Ave
#1
Rockville Centre, NY 11570

50 Maine Ave
Rockville Ctr, NY 11570
Phone (516) 508-3552

1220 Front St
Uniondale, NY 11553
Phone (516) 539-0518

526 Greengrove Ave
Uniondale, NY 11553
Phone (516) 977-2050

Practitioners & affiliated clinicians

Practitioners 310

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.

View all 310

NPI Registry JSON

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1104097294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 798",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "11571",
            "telephone_number": "516-705-1353",
            "fax_number": "516-705-3575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N. VILLAGE AVENUE",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "11571",
            "telephone_number": "516-705-1353",
            "fax_number": "516-705-3575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY MEDICAL CENTER",
        "enumeration_date": "2008-03-17",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "REILLY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "516-705-1353",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "178140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02898020",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; 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.