NPIMap

Individual provider Active NPI

Sanjay Godhwani, MD

  • Rheumatology Physician
  • Wading River, NY
National Provider Identifier
1174783567
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
266326 Issued in NY
Practice address
6144 Route 25a Ste 13
Wading River, NY 11792-2008
Phone
(631) 886-2844
Fax
(631) 886-2842
NPI assigned
Jun 10, 2008
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 266326 NY
Rheumatology Physician 207RR0500X 266326 NY Primary

Addresses

Primary practice location

6144 Route 25a Ste 13
Wading River, NY 11792-2008

Mailing address

6144 Route 25a Ste 13
Wading River, NY 11792-2008
Phone (631) 886-2844

Other practice location 1

101 Nicolls Road
HSC T16-020
Stony Brook, NY 11794-8160
Phone (631) 444-8478

Other identifiers 1

IdentifierTypeStateIssuer
03497523MedicaidNY

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
I20120919000133 NY Practitioner - RheumatologyPractitioner - Internal Medicine 6709034606 Practice locations: Shirley, NY; Wading River, NY

Care Compare profile

Medicare Care Compare
Specialty
RheumatologyAlso: Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2 Coraci Blvd
Shirley, NY 11967-4833
Phone (631) 886-2844

6144 Route 25a
Suite 13
Wading River, NY 11792-2008
Phone (631) 886-2844

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.79 of 100Reported as individual
Quality
68.18
Improvement activities
40
Cost
68.39

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
NK Medical PC PastSince Jan 2, 2014 Accepting new patients

Networks

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

Interoperability endpoints

  • Direct secure messaging: sanjay.godhwani.1@19019.direct.athenahealth.com

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 11

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": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1174783567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6144 ROUTE 25A STE 13",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117922008",
            "telephone_number": "631-886-2844",
            "fax_number": "631-886-2842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6144 ROUTE 25A STE 13",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117922008",
            "telephone_number": "631-886-2844",
            "fax_number": "631-886-2842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Nicolls Road",
            "address_2": "HSC T16-020",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "117948160",
            "country_code": "US",
            "telephone_number": "631-444-8478",
            "fax_number": "631-444-7546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GODHWANI",
        "first_name": "SANJAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-10",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "266326",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NY",
            "license": "266326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03497523",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wading River, NY

Sources for this page

Verify at the official NPI Registry.