NPIMap

Individual provider Active NPI

Justin M Liu, PA-C

  • Physician Assistant
  • Riverhead, NY
National Provider Identifier
1356837702
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
022149-1 Issued in NY
Practice address
31 Main Rd Ste 3
Riverhead, NY 11901
Phone
(631) 727-6308
Fax
(631) 369-8129
NPI assigned
Jul 9, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 022149-1 NY
Physician Assistant 363A00000X 022149-1 NY Primary

Addresses

Primary practice location

31 Main Rd Ste 3
Riverhead, NY 11901

Mailing address

1300 Roanoke Ave
Riverhead, NY 11901-2031
Phone (631) 727-6308

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180822003239 NY Practitioner - Physician Assistant 8628327707 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peconic Bay Primary Medical CareGroup PAC ID 7113817602, 72 clinicians

Practice addresses (Care Compare)

31 Main Rd
Suite 1
Riverhead, NY 11901-1953
Phone (631) 722-4400

34 Commerce Ave
Riverhead, NY 11901-3118
Phone (631) 727-1600

496 County Rd
111 BLDG B
Manorville, NY 11949-3386
Phone (631) 405-3200

64 Commerce Ave
Riverhead, NY 11901-4455
Phone (631) 369-5000

855 Montauk Hwy
Shirley, NY 11967-2153
Phone (631) 815-1968

Hospital & facility affiliations

  • Peconic Bay Medical Center Hospital, Riverhead, NY, CCN 330107
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
022149NYMDOccupational Therapist
022149-1NYMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Central Suffolk Hosptial CurrentSince Oct 8, 2018 Accepting new patients

Locations

1 Heroes Way
Riverhead, NY 11901
Phone (631) 548-6000

Networks

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

Interoperability endpoints

  • Direct secure messaging: jliu25842@northwell.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1356837702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012031",
            "telephone_number": "631-727-6308",
            "fax_number": "631-369-8129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 MAIN RD STE 3",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "11901",
            "telephone_number": "631-727-6308",
            "fax_number": "631-369-8129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU",
        "first_name": "JUSTIN",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-09",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "022149-1",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022149-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

Verify at the official NPI Registry.