Individual provider Active NPI

Jeremy Fertel, MD

  • Cardiovascular Disease Physician
  • Stony Brook, NY
National Provider Identifier
1285020628
Registry record updated Oct 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
307344-01 Issued in NY
Practice address
1320 Stony Brook Rd Ste 100
Stony Brook, NY 11790-2222
Phone
(631) 941-2273
NPI assigned
Apr 13, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Cardiovascular Disease Physician 207RC0000X 307344-01 NY Primary

Addresses

Primary practice location

1320 Stony Brook Rd Ste 100
Stony Brook, NY 11790-2222

Mailing address

1320 Stony Brook Rd Ste 100
Stony Brook, NY 11790-2222
Phone (631) 941-2273

Other practice location 1

111 E 210th St
Bronx, NY 10467-2401
Phone (718) 920-4321

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jeremy.fertal@sbcm.cernerdirect.com

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
I20210825001167 NY Practitioner - Cardiovascular Disease (Cardiology) 9234462052 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

26 Research Way
East Setauket, NY 11733-3526
Phone (631) 444-0580

301 E Main St
Bay Shore, NY 11706-8408
Phone (631) 941-2000

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
307344-01NYMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiac Ekg Interpretation, P. C. Cardiovascular Disease CurrentSince Aug 4, 2024 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Cardiovascular Disease CurrentSince Jul 14, 2021 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation PastSince Jul 17, 2021 Accepting new patients

Locations

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

26 Research Way
East Setauket, NY 11733
Phone (631) 444-0502

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

1320 Stony Brook Rd
Ste 100
Stony Brook, NY 11790
Phone (631) 941-2273

1320 Stony Brook Rd
Bldg D100
Stony Brook, NY 11790
Phone (631) 941-2273

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

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

Interoperability endpoints

  • Direct secure messaging: jeremy.fertal@sbcm.cernerdirect.com

Organizations & group practices 3

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 8

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": "1428883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1285020628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 STONY BROOK RD STE 100",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902222",
            "telephone_number": "631-941-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 STONY BROOK RD STE 100",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902222",
            "telephone_number": "631-941-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 E 210th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104672401",
            "country_code": "US",
            "telephone_number": "718-920-4321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERTEL",
        "first_name": "JEREMY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-13",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "307344-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeremy.fertal@sbcm.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1320 Stony Brook Rd Ste 100",
            "city": "Stony Brook",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117902222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.