NPIMap

Organization Active NPI

Quality Medical Management Corp

  • Certified Registered Nurse Anesthetist
  • Port Jefferson Station, NY
National Provider Identifier
1114502606
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
QUALITY MEDICAL MANAGEMENT CORP
Practice address
1110 Hallock Ave
Port Jefferson Station, NY 11776-1210
Phone
(631) 476-9100
NPI assigned
Mar 16, 2021
Last updated
Mar 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Authorized official

Name
Mike Reens
Title
Authorized Official
Phone
(631) 446-1190

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X Primary
Anesthesiology Physician 207L00000X

Addresses

Primary practice location

1110 Hallock Ave
Port Jefferson Station, NY 11776-1210

Mailing address

PO Box 577
Islip, NY 11751-0577
Phone (800) 516-5315

Other practice location 1

1149 Old Country Rd
Riverhead, NY 11901-2057
Phone (631) 591-9003

Other practice location 2

1324 Motor Pkwy Ste 101
Islandia, NY 11749-5226
Phone (631) 979-0222

Other practice location 3

160 Howells Rd Ste 16
Bay Shore, NY 11706-5320
Phone (631) 446-1190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, DC, PA, CA, TX, AZ, TN7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20210427000857 NY Part B Supplier - Clinic/Group Practice 5799193074 Receives reassigned benefits from 45 practitioners
Practice locations: Riverhead, NY; Port Jefferson Station, NY; Mineola, NY; Jamaica, NY; Long Island City, NY; Bronx, NY; Islandia, NY
O20230419002437 DC Part B Supplier - Clinic/Group Practice 5799193074 Receives reassigned benefits from 12 practitioners
Practice locations: Colmar Manor, MD
O20231214001576 PA Part B Supplier - Clinic/Group Practice 5799193074 Receives reassigned benefits from 7 practitioners
Practice locations: Cranberry Township, PA
O20240829003308 CA Part B Supplier - Clinic/Group Practice 5799193074 Receives reassigned benefits from 5 practitioners
Practice locations: Irvine, CA
O20250131000164 TX Part B Supplier - Clinic/Group Practice 5799193074 Receives reassigned benefits from 2 practitioners
Practice locations: Lubbock, TX
O20250321001816 AZ Part B Supplier - Clinic/Group Practice 5799193074 Receives reassigned benefits from 2 practitioners
Practice locations: Chandler, AZ
O20260625004569 TN Part B Supplier - Clinic/Group Practice 5799193074 Receives reassigned benefits from 1 practitioner
Practice locations: Talbott, TN

National Provider Directory

National Provider Directory

Locations

2394 N Alma School Rd
Ste 1
Chandler, AZ 85224
Phone (480) 963-0700

160 Howells Rd
Ste 12
Bay Shore, NY 11706

160 Howells Rd
Ste 16
Bay Shore, NY 11706
Phone (631) 446-1190

3636 33rd St
Ste 204
Long Island City, NY 11106
Phone (631) 446-1190

300 Old Country Rd
Fl 4
Mineola, NY 11501
Phone (516) 747-9232

Practitioners & affiliated clinicians

Practitioners 134

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 134

NPI Registry JSON

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616630400000",
    "number": "1114502606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 577",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117510577",
            "telephone_number": "800-516-5315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 HALLOCK AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761210",
            "telephone_number": "631-476-9100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1149 Old Country Rd",
            "address_purpose": "LOCATION",
            "city": "Riverhead",
            "state": "NY",
            "postal_code": "119012057",
            "country_code": "US",
            "telephone_number": "631-591-9003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1324 Motor Pkwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "Islandia",
            "state": "NY",
            "postal_code": "117495226",
            "country_code": "US",
            "telephone_number": "631-979-0222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "160 Howells Rd Ste 16",
            "address_purpose": "LOCATION",
            "city": "Bay Shore",
            "state": "NY",
            "postal_code": "117065320",
            "country_code": "US",
            "telephone_number": "631-446-1190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "QUALITY MEDICAL MANAGEMENT CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "REENS",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "631-446-1190"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; 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.