Organization Active NPI

North Suffolk Medical Care, PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Calverton, NY
National Provider Identifier
1114022084
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
NORTH SUFFOLK MEDICAL CARE, PC
Practice address
4480 Middle Country Rd
Calverton, NY 11933-1185
Phone
(631) 208-2919
Fax
(631) 208-0976
NPI assigned
Sep 14, 2006
Last updated
Feb 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

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

Authorized official

Name
John P O'Connor, MDNPI 1811917578
Title
Owner
Phone
(631) 208-2919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU Primary

Addresses

Primary practice location

4480 Middle Country Rd
Calverton, NY 11933-1185

Mailing address

4480 Middle Country Rd
Calverton, NY 11933-1185
Phone (630) 208-2919

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000617 NY Part B Supplier - Clinic/Group Practice 1951294784 Receives reassigned benefits from 2 practitioners
Practice locations: Calverton, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D1072138North Suffolk Medical Care PC4480 Middle Country Road, Calverton, NY 11933Certificate of waiverAug 8, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1114022084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 MIDDLE COUNTRY RD",
            "city": "CALVERTON",
            "state": "NY",
            "postal_code": "119331185",
            "telephone_number": "630-208-2919",
            "fax_number": "631-208-0976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4480 MIDDLE COUNTRY RD",
            "city": "CALVERTON",
            "state": "NY",
            "postal_code": "119331185",
            "telephone_number": "631-208-2919",
            "fax_number": "631-208-0976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SUFFOLK MEDICAL CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2025-02-21",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-208-2919",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Calverton, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.