NPIMap

Organization Active NPI

Middle Country Endocrinology, PC

  • Endocrinology, Diabetes & Metabolism Physician
  • Smithtown, NY
National Provider Identifier
1295068930
Registry record updated Sep 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
205106 Issued in NY
Legal business name
MIDDLE COUNTRY ENDOCRINOLOGY, PC
Practice address
285 Middle Country Rd
Suite 105
Smithtown, NY 11787-2978
Phone
(631) 509-0390
NPI assigned
Sep 14, 2009
Last updated
Sep 14, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2009

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

Authorized official

Name
Dr. Sherry K Sussman, MDNPI 1235176280
Title
Ceo
Phone
(631) 509-0390

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 205106 NY Primary

Addresses

Primary practice location

285 Middle Country Rd
Suite 105
Smithtown, NY 11787-2978

Mailing address

285 Middle Country Rd
Suite 105
Smithtown, NY 11787-2978
Phone (631) 509-0390

Other identifiers 1

IdentifierTypeStateIssuer
1235176280OtherNPI # INDIVIDUAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091022000358 NY Part B Supplier - Clinic/Group Practice 9032256169 Receives reassigned benefits from 8 practitioners
Practice locations: Smithtown, NY

National Provider Directory

National Provider Directory

Locations

285 E Middle Country Rd
Ste 105
Smithtown, NY 11787
Phone (631) 509-0390

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CJCEAD

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252886400000",
    "number": "1295068930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 MIDDLE COUNTRY RD",
            "address_2": "SUITE 105",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872978",
            "telephone_number": "631-509-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 MIDDLE COUNTRY RD",
            "address_2": "SUITE 105",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872978",
            "telephone_number": "631-509-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLE COUNTRY ENDOCRINOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-14",
        "last_updated": "2009-09-14",
        "status": "A",
        "authorized_official_last_name": "SUSSMAN",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "631-509-0390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NY",
            "license": "205106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI # INDIVIDUAL",
            "identifier": "1235176280",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; 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.