NPIMap

Individual provider Active NPI

Derek Noel Mattimoe, MD

  • Family Medicine Physician
  • Stony Brook, NY
National Provider Identifier
1164494613
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
216334 Issued in NY
Practice address
2500 Nesconset Hwy
BLDG 7D
Stony Brook, NY 11790-2555
Phone
(631) 751-3322
Fax
(631) 751-3844
NPI assigned
Feb 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 216334 NY Primary

Addresses

Primary practice location

2500 Nesconset Hwy
BLDG 7D
Stony Brook, NY 11790-2555

Mailing address

2500 Nesconset Hwy
BLDG 7D
Stony Brook, NY 11790-2555
Phone (631) 751-3322

Other identifiers 1

IdentifierTypeStateIssuer
02068326MedicaidNY

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
I20050707000962 NY Practitioner - Family Practice 2264478585 Reassigns benefits to 1 organization
Practice locations: Stony Brook, NY

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Columbia University College of Physicians and Surgeons, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

2500 Nesconset Hwy
BLDG 7D
Stony Brook, NY 11790-2566
Phone (631) 751-3322

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
216334NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Physician Partners, PC Current Accepting new patients
CHS Physician Partners, P.C CurrentSince Feb 1, 2016 Accepting new patients

Locations

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

2500 Nesconset Hwy
Bldg 7D
Stony Brook, NY 11790
Phone (631) 751-3322

Networks

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

Interoperability endpoints

  • Direct secure messaging: dmattimoe56585@direct-chsli.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1164494613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NESCONSET HWY",
            "address_2": "BLDG 7D",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902555",
            "telephone_number": "631-751-3322",
            "fax_number": "631-751-3844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NESCONSET HWY",
            "address_2": "BLDG 7D",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902555",
            "telephone_number": "631-751-3322",
            "fax_number": "631-751-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTIMOE",
        "first_name": "DEREK",
        "middle_name": "NOEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "216334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02068326",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.