Individual provider Active NPI

Kevin Pereira, MD

  • Emergency Medicine Physician
  • Port Jefferson, NY
National Provider Identifier
1124588181
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
313702 Issued in NY
Practice address
75 N Country Rd
Port Jefferson, NY 11777-2119
Phone
(631) 473-1320
NPI assigned
Mar 24, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 313702 NY Primary

Addresses

Primary practice location

75 N Country Rd
Port Jefferson, NY 11777-2119

Mailing address

75 N Country Rd
Port Jefferson, NY 11777-2119
Phone (631) 473-1320

Other practice location 1

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-2499

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220318001554 NY Practitioner - Emergency Medicine 1951633825 Reassigns benefits to 4 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Emergency Physicians, University Faculty Practice Corporat Emergency Medicine CurrentSince Aug 21, 2023 Accepting new patients
North Shore-Lij Medical PC Emergency Medicine CurrentSince Jun 29, 2022 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Optum Urgent Care, PLLC CurrentSince Feb 14, 2022 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients

Locations

555 N Broadway
Jericho, NY 11753
Phone (516) 597-5070

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

2800 Marcus Ave
New Hyde Park, NY 11042
Phone (516) 622-6131

300 Community Dr
Plandome, NY 11030

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

1 Heroes Way
Riverhead, NY 11901
Phone (631) 548-6000

Philadelphia, PA 19195

Networks

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

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1553385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1124588181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-473-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-473-1320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Nicolls Rd",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "117940001",
            "country_code": "US",
            "telephone_number": "631-444-2499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREIRA",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-24",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "313702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.