Peter A Boulukos, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

141481-1 Issued in NY

Practice address

471 Montauk Hwy
West Islip, NY 11795-4414

Phone

(631) 849-1050

Fax

(631) 849-1052

NPI assigned

Dec 4, 2006

Last updated

Dec 13, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Specialty

Anesthesiology

Education

Other, 1974

Medicare assignment

May accept Medicare assignment

Group practices

Suffolk Anesthesia Services PLLCGroup PAC ID 2567609464, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Suffolk Anesthesia Services PLLC

  • Anesthesiology Physician
  • West Islip, NY
  • NPI 1871869305
  Medicare reassignment Care Compare group
• Long Island Anesthesia Physicians LLP

  • Anesthesiology Physician
  • Rocky Point, NY
  • NPI 1952387276
  Medicare reassignment NPD
• Warren Lobo, MD, PC

  • Anesthesiology Physician
  • Babylon, NY
  • NPI 1134357262
  NPD (past)

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1184782260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 GROUSE LN",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117431029",
            "telephone_number": "516-356-3888",
            "fax_number": "631-849-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 MONTAUK HWY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954414",
            "telephone_number": "631-849-1050",
            "fax_number": "631-849-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULUKOS",
        "first_name": "PETER",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "141481-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHILED",
            "identifier": "PB027A5210",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "141481-2 CAN",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00535199",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Borimir Darakchiev MD PC
• Boris Matusevich Physician PC
• Halina Borowski, M.D.
• Melissa J Bosco, PA
• Tammy Ann Botte, MS.ED.
• Anna Brady
• Brain Care Long Island PLLC
• Robert Matthew Bramante, MD
• Stephanie Dawn Teresa Brassil, AGNP
• Jillian Rose Brauer-Lum, PA-C

• Anesthesiology Physician in West Islip, NY
• Providers in West Islip, NY by specialty
• Anesthesiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.