NPIMap

Organization Active NPI

John T Mather Memorial Hospital

  • Obesity Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
National Provider Identifier
1366816894
Registry record updated Apr 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Internal Medicine) PhysicianTaxonomy code 207RB0002X
Legal business name
JOHN T MATHER MEMORIAL HOSPITAL
Practice address
75 N Country Rd
Suite 201
Port Jefferson, NY 11777-2119
Phone
(631) 689-0220
Fax
(631) 417-3042
NPI assigned
Nov 20, 2015
Last updated
Apr 8, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2016

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

Authorized official

Name
Joseph Wisnoski
Title
VP Finance
Phone
(631) 473-1320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Internal Medicine) Physician 207RB0002X Primary

Addresses

Primary practice location

75 N Country Rd
Suite 201
Port Jefferson, NY 11777-2119

Mailing address

100 Highlands Blvd
Box 9
Port Jefferson, NY 11777-2320
Phone (631) 686-7809

Other names 1

  • Bariatric Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150804004898 NY Part B Supplier - Hospital Department(S) 1254237753 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Jefferson, NY

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 110

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.

View all 110

NPI Registry JSON

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

{
    "created_epoch": "1447977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460073600000",
    "number": "1366816894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HIGHLANDS BLVD",
            "address_2": "BOX 9",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772320",
            "telephone_number": "631-686-7809",
            "fax_number": "631-686-7972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "address_2": "SUITE 201",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-689-0220",
            "fax_number": "631-417-3042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T MATHER MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-20",
        "last_updated": "2016-04-08",
        "status": "A",
        "authorized_official_last_name": "WISNOSKI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "631-473-1320"
    },
    "taxonomies": [
        {
            "code": "207RB0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bariatric Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2016; 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.