NPIMap

Individual provider Active NPI

Philip D Degaetano, D.O.

  • Family Medicine Physician
  • West Islip, NY
National Provider Identifier
1174810436
Registry record updated Jun 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
052971 Issued in CT
Practice address
1000 Montauk Hwy
West Islip, NY 11795-4927
Phone
(631) 806-1357
NPI assigned
Jul 6, 2011
Last updated
Jun 3, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 052971 CT Primary

Addresses

Primary practice location

1000 Montauk Hwy
West Islip, NY 11795-4927

Mailing address

1000 Montauk Hwy
West Islip, NY 11795-4927

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
I20160303001227 NY Practitioner - Family Practice 8224255310 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

405 Sayville Blvd
Sayville, NY 11782-2015
Phone (631) 806-1357

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
72.13
Promoting interoperability
91
Improvement activities
40
Cost
75.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
052971CTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Optum Urgent Care, PLLC CurrentSince Jan 23, 2016 Accepting new patients
Jared Hertz DO PC CurrentSince May 1, 2024 Accepting new patients
Philip Degaetano D.O.P.C. Family Medicine CurrentSince Jul 1, 2024 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Our Lady of Consolation Geriatric Care Center Past Accepting new patients
Paljr LLC Past Accepting new patients
Suffolk Surgery PLLC PastSince Nov 10, 2024 Accepting new patients
Good Samaritan Hospital Medical Center Past Accepting new patients

Locations

148 Merrick Rd
Amityville, NY 11701
Phone (631) 789-2556

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

150 Sunrise Hwy
Ste 101
Lindenhurst, NY 11757
Phone (631) 209-7080

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

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

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

700 Old Country Rd
Ste 205
Plainview, NY 11803
Phone (516) 822-1433

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Philadelphia, PA 19195

Organizations & group practices 9

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 6

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": "1309910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401753600000",
    "number": "1174810436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MONTAUK HWY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MONTAUK HWY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954927",
            "telephone_number": "631-806-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGAETANO",
        "first_name": "PHILIP",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-06",
        "last_updated": "2014-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "052971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Islip, NY

Sources for this page

Verify at the official NPI Registry.