NPIMap

Organization Active NPI

Brookhaven Memorial Hospital Medical Center

  • Family Medicine Physician
  • Bellport, NY
National Provider Identifier
1184041899
Registry record updated Aug 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER
Practice address
515 Bellport Ave
Bellport, NY 11713-1711
Phone
(631) 227-6600
Fax
(631) 286-8290
NPI assigned
Mar 20, 2014
Organization subpart
Yes
Parent organization
BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2014

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

Authorized official

Name
Mrs. Brenda J Farrell
Title
Chief Financial Officere
Phone
(631) 654-7175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

515 Bellport Ave
Bellport, NY 11713-1711

Mailing address

515 Bellport Ave
Bellport, NY 11713-1711
Phone (631) 227-6600

Other names 1

  • Brookhaven Memorial Hospital Bellport Primary Care Center Physicians Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031218000695 NY Part B Supplier - Clinic/Group Practice 9739090051 Receives reassigned benefits from 113 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, NY; Westhampton, NY; Shirley, NY; Patchogue, NY; Hauppauge, NY; East Patchogue, NY; Brookhaven, NY; Bellport, NY

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Brookhaven Hospital PA13 organizations share this tax ID, including this one
Part of
Brookhaven Hospital PA

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408665600000",
    "number": "1184041899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 BELLPORT AVE",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "117131711",
            "telephone_number": "631-227-6600",
            "fax_number": "631-286-8290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 BELLPORT AVE",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "117131711",
            "telephone_number": "631-227-6600",
            "fax_number": "631-286-8290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER",
        "enumeration_date": "2014-03-20",
        "last_updated": "2014-08-22",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICERE",
        "authorized_official_telephone_number": "631-654-7175",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookhaven Memorial Hospital Bellport Primary Care Center Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.