NPIMap

Organization Active NPI

County of Suffolk

  • Public Health or Welfare Agency
  • Great River, NY
National Provider Identifier
1285750737
Registry record updated Mar 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
License
5155200R Issued in NY
Legal business name
COUNTY OF SUFFOLK
Practice address
3500 Sunrise Hwy Ste 124
Pob 9006
Great River, NY 11739-1001
Phone
(631) 854-0182
Fax
(631) 854-0199
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2013

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

Authorized official

Name
Darlene A Wilson
Title
Administrator II
Phone
(631) 854-0193

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X 5155200R NY Primary

Addresses

Primary practice location

3500 Sunrise Hwy Ste 124
Pob 9006
Great River, NY 11739-1001

Mailing address

3500 Sunrise Hwy Ste 124
Pob 9006
Great River, NY 11739-1001
Phone (631) 854-0182

Other identifiers 1

IdentifierTypeStateIssuer
00473170MedicaidNY

Other names 1

  • Suffolk County Department of Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317000525 NY Part B Supplier - Clinic/Group Practice 2264344316 Receives reassigned benefits from 17 practitioners
13 other NPIs on this enrollment
Practice locations: Farmingville, NY; Riverhead, NY; Yaphank, NY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Tax ID family
Anjumon a Amin17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363651200000",
    "number": "1285750737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 SUNRISE HWY STE 124",
            "address_2": "POB 9006",
            "city": "GREAT RIVER",
            "state": "NY",
            "postal_code": "117391001",
            "telephone_number": "631-854-0182",
            "fax_number": "631-854-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 SUNRISE HWY STE 124",
            "address_2": "POB 9006",
            "city": "GREAT RIVER",
            "state": "NY",
            "postal_code": "117391001",
            "telephone_number": "631-854-0182",
            "fax_number": "631-854-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SUFFOLK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2013-03-19",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR II",
        "authorized_official_telephone_number": "631-854-0193"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NY",
            "license": "5155200R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473170",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suffolk County Department of Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Great River, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.