Individual provider Active NPI

Michael Suzzivalli

  • Physician Assistant
  • Port Jefferson, NY
National Provider Identifier
1194737973
Registry record updated Jan 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
008264 Issued in NY
Practice address
635 Belle Terre Rd
Suite #204
Port Jefferson, NY 11777-1935
Phone
(631) 474-0008
Fax
(631) 474-0224
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 008264 NY Primary

Addresses

Primary practice location

635 Belle Terre Rd
Suite #204
Port Jefferson, NY 11777-1935

Mailing address

635 Belle Terre Rd
Suite #204
Port Jefferson, NY 11777-1935
Phone (631) 474-0008

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041108000347 NY Practitioner - Physician Assistant 6305809740 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
True North Medical Group PCGroup PAC ID 7012194806, 185 clinicians

Practice addresses (Care Compare)

3480 Veterans Memorial Hwy
Bohemia, NY 11716-1068
Phone (631) 289-0338

36 Lincoln Ave
Rockville Centre, NY 11570-5768
Phone (516) 536-2800

635 Belle Terre Rd
Suite 204
Port Jefferson, NY 11777-1977
Phone (631) 474-0224

75 N Country Rd
Port Jefferson, NY 11777-2119
Phone (631) 473-1320

788 Harrison Ave
Riverhead, NY 11901-2744
Phone (631) 591-3801

Hospital & facility affiliations

  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
True North Medical Group PC CurrentSince Jun 3, 2019 Accepting new patients
True North Medical Group PC Physician Assistant CurrentSince Jun 3, 2019 Accepting new patients
North Shore - Lij Medical PC CurrentSince Apr 27, 2015 Accepting new patients
True North Medical Group PC Past Accepting new patients

Locations

660 Broadway
Massapequa, NY 11758
Phone (516) 730-2222

300 Community Dr
Plandome, NY 11030

75 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 463-1320

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

635 Belle Terre Rd
Ste 204
Prt Jefferson, NY 11777
Phone (631) 474-0008

788 Harrison Ave
Riverhead, NY 11901
Phone (631) 591-3801

36 Lincoln Ave
Fl 2
Rockville Ctr, NY 11570
Phone (516) 766-2176

36 Lincoln Ave
Fl 3
Rockville Ctr, NY 11570

686 County Road 39A
Southampton, NY 11968
Phone (631) 283-0355

972 Brush Hollow Rd
Westbury, NY 11590

45 Crossways Park Dr W
Woodbury, NY 11797
Phone (516) 422-8080

Networks

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

Interoperability endpoints

  • Direct secure messaging: michaelsuzzivalli@nslijmedgr.allscriptsdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264550400000",
    "number": "1194737973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 BELLE TERRE RD",
            "address_2": "SUITE #204",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771935",
            "telephone_number": "631-474-0008",
            "fax_number": "631-474-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 BELLE TERRE RD",
            "address_2": "SUITE #204",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771935",
            "telephone_number": "631-474-0008",
            "fax_number": "631-474-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUZZIVALLI",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2010-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.