NPIMap

Individual provider Active NPI

Keith Webb Harris II, DO

  • Pulmonary Disease Physician
  • Port Jefferson Station, NY
National Provider Identifier
1114026853
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
236259-1 Issued in NY
Practice address
1500 Route 112 Ste B
Port Jefferson Station, NY 11776-8055
Phone
(631) 978-7633
Fax
(631) 621-4115
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 236259-1 NY Primary

Addresses

Primary practice location

1500 Route 112 Ste B
Port Jefferson Station, NY 11776-8055

Mailing address

500 Commack Rd Unit 206
Commack, NY 11725-5022
Phone (631) 675-2125

Other practice location 1

47 Commerce Ave Ste 1
Riverhead, NY 11901-3106
Phone (631) 978-7633

Other practice location 2

200 Motor Pkwy Ste C-16
Hauppauge, NY 11788-5114
Phone (631) 978-7633

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kharris@nsc.direct.gemmsnest.com Direct

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
I20080712000004 NY Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 5597837245 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
Philadelphia College of Osteopathic Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-1750

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-0580

1300 Roanoke Ave
Riverhead, NY 11901-2031
Phone (631) 548-6000

26 Research Way
East Setauket, NY 11733-3526
Phone (631) 444-0580

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
236259-1NYMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince May 14, 2018 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Pulmonary Disease CurrentSince May 14, 2018 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients

Locations

200 Motor Pkwy
Ste C16
Hauppauge, NY 11788
Phone (631) 638-4933

200 Motor Pkwy
Hauppauge, NY 11788
Phone (631) 234-5666

1500 Route 112
Ste B
Port Jefferson Station, NY 11776
Phone (631) 343-4184

75 N Country Rd
Ste 201
Prt Jefferson, NY 11777
Phone (631) 686-2575

75 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 463-1320

47 Commerce Ave
Ste 1
Riverhead, NY 11901
Phone (631) 978-7633

100 Nicolls Rd
#13202
Stony Brook, NY 11794

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Networks

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

Interoperability endpoints

  • Direct secure messaging: keith.harris@sbcm.cernerdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1114026853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 COMMACK RD UNIT 206",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117255022",
            "telephone_number": "631-675-2125",
            "fax_number": "631-675-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112 STE B",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768055",
            "telephone_number": "631-978-7633",
            "fax_number": "631-621-4115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "47 Commerce Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Riverhead",
            "state": "NY",
            "postal_code": "119013106",
            "country_code": "US",
            "telephone_number": "631-978-7633",
            "fax_number": "631-621-4115",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Motor Pkwy Ste C-16",
            "address_purpose": "LOCATION",
            "city": "Hauppauge",
            "state": "NY",
            "postal_code": "117885114",
            "country_code": "US",
            "telephone_number": "631-978-7633",
            "fax_number": "631-621-4115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "KEITH",
        "middle_name": "WEBB",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "236259-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kharris@nsc.direct.gemmsnest.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1500 Route 112 Ste B",
            "city": "Port Jefferson Station",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117768055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.