NPIMap

Individual provider Active NPI

Christopher Taiwo

  • Physician Assistant
  • Stony Brook, NY
National Provider Identifier
1285039636
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00847500 Issued in NJ
Practice address
Stony Brook Medicine
Dept. of Emergency Medicine, HSC, Level 4, Room 080
Stony Brook, NY 11794-8350
Phone
(631) 444-2478
NPI assigned
Oct 28, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00847500 NJ Primary
Physician Assistant 363A00000X 018159 NY

Addresses

Primary practice location

Stony Brook Medicine
Dept. of Emergency Medicine, HSC, Level 4, Room 080
Stony Brook, NY 11794-8350

Mailing address

PO Box 1554
Stony Brook, NY 11794-8350
Phone (631) 444-2478

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150317002493 NY Practitioner - Physician Assistant 6507183217 Reassigns benefits to 8 organizations
I20240627001256 NJ Practitioner - Physician Assistant 6507183217 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Small Hospital Innovations LLCGroup PAC ID 0840415444, 95 clinicians

Practice addresses (Care Compare)

111 Central Ave
Newark, NJ 07102-1909
Phone (973) 877-5000

Merit-based Incentive Payment System (MIPS)

Final score
83.2 of 100Reported as group
Quality
60.03
Promoting interoperability
99
Improvement activities
40
Cost
73.33

Merit-based Incentive Payment System (MIPS)

Final score
97.33 of 100Reported as group
Improvement activities
40
Cost
77.32

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018159NYMDOccupational Therapist
25MP00847500NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Nov 17, 2024 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Nov 17, 2024 Accepting new patients
Small Hospital Innovations LLC CurrentSince Jul 15, 2025 Accepting new patients
Jersey Intensivist Associates LLC CurrentSince Aug 11, 2025 Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
St James Mercy Hospital Past Accepting new patients

Locations

111 Central Ave
Newark, NJ 07102
Phone (973) 877-5060

66 W Gilbert St
Ste 100
Tinton Falls, NJ 07701
Phone (201) 795-8637

1 Hamilton Health Pl
Trenton, NJ 08690
Phone (609) 584-6763

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

234 E 85th St
New York, NY 10028
Phone (212) 241-6585

5 E 98th St
New York, NY 10029
Phone (212) 241-3986

150 E 42nd St
Fl 9
New York, NY 10017
Phone (646) 605-8119

Networks

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

Organizations & group practices 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1285039636",
    "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": "117948350",
            "telephone_number": "631-444-2478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STONY BROOK MEDICINE",
            "address_2": "DEPT. OF EMERGENCY MEDICINE, HSC, LEVEL 4, ROOM 080",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948350",
            "telephone_number": "631-444-2478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAIWO",
        "first_name": "CHRISTOPHER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-28",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00847500",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018159",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.