NPIMap

Organization Active NPI

Stony Brook Internists, University Faculty Practice Corporation

  • Nephrology Physician
  • Stony Brook, NY
National Provider Identifier
1215976337
Registry record updated Nov 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION
Practice address
Suny @ Stony Brook
HSC, L16, RM 020
Stony Brook, NY 11794-0001
Phone
(631) 444-2448
NPI assigned
Jun 5, 2006
Last updated
Nov 21, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 21, 2013

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

Authorized official

Name
Dr. Vincent Yang, MD, PHD
Title
Chair Person
Phone
(631) 444-2448

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

Suny @ Stony Brook
HSC, L16, RM 020
Stony Brook, NY 11794-0001

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988
Phone (631) 444-2448

Other identifiers 2

IdentifierTypeStateIssuer
00615265MedicaidNY
CB8937OtherNYRAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040416000248 NY Part B Supplier - Clinic/Group Practice 9133019821 Receives reassigned benefits from 270 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Centereach, NY; Stony Brook, NY; Smithtown, NY; Lake Grove, NY; Islip Terrace, NY; Greenport, NY; East Setauket, NY; Commack, NY…

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
David J Volkman

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384992000000",
    "number": "1215976337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1554",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900988",
            "telephone_number": "631-444-2448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY @ STONY BROOK",
            "address_2": "HSC, L16, RM 020",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-2448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION",
        "enumeration_date": "2006-06-05",
        "last_updated": "2013-11-21",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_title_or_position": "CHAIR PERSON",
        "authorized_official_telephone_number": "631-444-2448",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00615265",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "CB8937",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; 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.