Individual provider Active NPI

Jason C Ganz, MD

  • Plastic Surgery Physician
  • East Setauket, NY
National Provider Identifier
1215950910
Registry record updated Jun 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
60-233290 Issued in NY
Practice address
24 Research Way
East Setauket, NY 11733-3487
Phone
(631) 444-4666
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 60-233290 NY Primary
Surgery of the Hand (Plastic Surgery) Physician 2082S0105X 60-233290 NY

Addresses

Primary practice location

24 Research Way
East Setauket, NY 11733-3487

Mailing address

24 Research Way
East Setauket, NY 11733-3487
Phone (631) 444-4666

Other identifiers 7

IdentifierTypeStateIssuer
P00372950OtherOHMEDICARE RAILROAD
7720723OtherOHAETNA
000000503657OtherOHANTHEM
363543OtherOHWELLCARE MEDICAID
000000221046OtherOHUNISON
743421OtherOHBUCKEYE MEDICAID
2595615MedicaidOH

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090310000510 NY Practitioner - Plastic and Reconstructive SurgeryPractitioner - Hand Surgery 3577517341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive SurgeryAlso: Hand Surgery
Education
New York University Medical College - NLG, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

255 W Montauk Hwy
Life Care Ctr
Hampton Bays, NY 11946
Phone (631) 723-5000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision22
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60-233290NYMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Surgical Associates, University Faculty Practice Corporati CurrentSince Jul 6, 2009 Accepting new patients
Lucy Webb Hayes National Training School for Deaconsses & Missonaries Past Accepting new patients
Stony Brook Orthopaedic Associates, University Faculty Practice Corpor Past Accepting new patients
Westchester County Health Care Corp Past Accepting new patients
Inpatient Consultants of Texas, PLLC. Past Accepting new patients

Locations

24 Research Way
Ste 102A
East Setauket, NY 11733

4 Smith Haven Mall
Ste 103
Lake Grove, NY 11755

24 Research Way
Setauket, NY 11733
Phone (631) 444-4666

37 Research Way
Setauket, NY 11733
Phone (631) 444-4121

Networks

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

Interoperability endpoints

  • Direct secure messaging: jason.ganz@direct.stonybrookmedicine.edu

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 7

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245715200000",
    "number": "1215950910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 RESEARCH WAY",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333487",
            "telephone_number": "631-444-4666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 RESEARCH WAY",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333487",
            "telephone_number": "631-444-4666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANZ",
        "first_name": "JASON",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2009-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NY",
            "license": "60-233290",
            "primary": true
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "NY",
            "license": "60-233290",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00372950",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7720723",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000503657",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE MEDICAID",
            "identifier": "363543",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000221046",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE MEDICAID",
            "identifier": "743421",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2595615",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

Verify at the official NPI Registry.