Active NPI
Peter Anthony Kelt, MD
- General Practice Physician
- Shelter Island, NY
National Provider Identifier
1124092408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 153757-1
- Practice address
- 44 Route 114
Shelter Island, NY 11964-0880 - Phone
- (631) 749-9130
- Fax
- (631) 749-9134
- NPI assigned
- Feb 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 153757-1 | NY | |
| General Practice Physician | 208D00000X | 153757-1 | NY | Primary |
Addresses
Primary practice location
44 Route 114
Shelter Island, NY 11964-0880
Mailing address
44 South Ferry Road
Box 880
Shelter Island, NY 11964-0880
Phone (631) 749-9130
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00789524 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- General Practice
- Education
- Tulane University School of Medicine, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
44 S Ferry Rd
Shelter Island, NY 11964-0880
Phone (631) 749-9130
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 153757-1 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New York University | General Practice | Current | Accepting new patients |
| New York University | Current | Accepting new patients |
Locations
340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064
Networks
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Organizations & group practices 2
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.
-
dba NYU Faculty Group Practice
- Cardiovascular Disease Physician
- Boynton Beach, FL
- NPI 1285826438
General Practice, NY
-
dba NYU Langone Ambulatory Care Chelsea
- Physical Medicine & Rehabilitation Physician
- Boynton Beach, FL
- NPI 1104787613
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Stony Brook Southampton Hospital
- General Acute Care Hospital
- Southampton, NY
- NPI 1033224704
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1225507114
-
- General Acute Care Hospital
- Greenport, NY
- NPI 1881690691
-
- General Acute Care Hospital
- Stony Brook, NY
- NPI 1972523348
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644364800000",
"number": "1124092408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 SOUTH FERRY ROAD",
"address_2": "BOX 880",
"city": "SHELTER ISLAND",
"state": "NY",
"postal_code": "119640880",
"telephone_number": "631-749-9130",
"fax_number": "631-749-9134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 ROUTE 114",
"city": "SHELTER ISLAND",
"state": "NY",
"postal_code": "119640880",
"telephone_number": "631-749-9130",
"fax_number": "631-749-9134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELT",
"first_name": "PETER",
"middle_name": "ANTHONY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-14",
"last_updated": "2022-02-09",
"certification_date": "2022-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "153757-1",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NY",
"license": "153757-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00789524",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelter Island, NY
- Bernadette Ann Gildea, LCSW
- JH Community Services LLC
- JH Community Services of Il LLC (JH Community Services LLC)
- Jr Smith Professional Services (Shelter Island Homecare Agency)
- Kyle Karen
- Margaret Anne Larsen Mathews, MS. CCC- SLP
- Kathleen M Lynch, LMHC
- Daniel Thomas Moran, DDS
- Jaycie Lynn Mosher, R-DMT, LCAT
- Michele R Pepey, SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.