Active NPI
Christopher Paul Antipas, PH.D.
- Clinical Psychologist
- Port Jefferson Station, NY
National Provider Identifier
1326084617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 010539-1
- Practice address
- 1350 Route 112
Port Jefferson Station, NY 11776-3078 - Phone
- (631) 745-9005
- NPI assigned
- Jun 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 010539-1 | NY | Primary |
Addresses
Primary practice location
1350 Route 112
Port Jefferson Station, NY 11776-3078
Mailing address
1 Lilac Dr
Stony Brook, NY 11790-1416
Phone (631) 689-2560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01651165 | Medicaid | NY |
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101013001166 | NY | Practitioner - Clinical Psychologist | 1456543057 | Practice locations: Port Jefferson Station, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1350 Route 112
Port Jefferson Station, NY 11776-3078
Phone (631) 745-9005
1360 Route 112
Port Jefferson Station, NY 11776-3078
Phone (631) 745-9005
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280707200000",
"number": "1326084617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 LILAC DR",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117901416",
"telephone_number": "631-689-2560",
"fax_number": "631-246-6299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 ROUTE 112",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117763078",
"telephone_number": "631-745-9005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTIPAS",
"first_name": "CHRISTOPHER",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2010-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "010539-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01651165",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson Station, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.