NPIMap

Organization Active NPI

St. Johnland Nursing Center, Inc.

  • Internal Medicine Physician
  • Kings Park, NY
National Provider Identifier
1336219658
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5157311N Issued in NY
Legal business name
ST. JOHNLAND NURSING CENTER, INC.
Practice address
395 Sunken Meadow Rd
Kings Park, NY 11754-1000
Phone
(631) 269-5800
Fax
(631) 269-5876
NPI assigned
Nov 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Mary Jean Weber, LNHA
Title
Ceo - Administrator
Phone
(631) 269-5800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 5157311N NY Primary

Addresses

Primary practice location

395 Sunken Meadow Rd
Kings Park, NY 11754-1000

Mailing address

395 Sunken Meadow Rd
Kings Park, NY 11754-1000
Phone (631) 269-5800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311000863 NY Part B Supplier - Clinic/Group Practice 9234028929 Receives reassigned benefits from 6 practitioners
Practice locations: Kings Park, NY

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
St Johnland Nursing Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336219658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 SUNKEN MEADOW RD",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "117541000",
            "telephone_number": "631-269-5800",
            "fax_number": "631-269-5876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 SUNKEN MEADOW RD",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "117541000",
            "telephone_number": "631-269-5800",
            "fax_number": "631-269-5876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHNLAND NURSING CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WEBER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "CEO - ADMINISTRATOR",
        "authorized_official_telephone_number": "631-269-5800",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "5157311N",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kings Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.