NPIMap

Organization Active NPI

John T. Mather Memorial Hospital

  • Psychiatry Physician
  • Port Jefferson Station, NY
National Provider Identifier
1376642371
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
JOHN T. MATHER MEMORIAL HOSPITAL
Practice address
75 N Country Rd
Port Jefferson Station, NY 11777-2119
Phone
(631) 473-1320
Fax
(631) 686-7972
NPI assigned
Sep 22, 2006
Last updated
Jan 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

75 N Country Rd
Port Jefferson Station, NY 11777-2119

Mailing address

PO Box 6435
Brattleboro, VT 05302-6435
Phone (631) 473-1320

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040316000754 NY Part B Supplier - Clinic/Group Practice 1254237753 Receives reassigned benefits from 318 practitioners
14 other NPIs on this enrollment
Practice locations: Port Jefferson, NY; Port Jefferson Station, NY

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
John Mather Mem Hos-STR T11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

100 Highlands Blvd
Ste 303
Port Jefferson, NY 11777
Phone (631) 775-2460

170 N Country Rd
Ste 3
Port Jefferson, NY 11777
Phone (631) 775-2426

Practitioners & affiliated clinicians

Practitioners 336

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 336

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1376642371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6435",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053026435",
            "telephone_number": "631-473-1320",
            "fax_number": "631-686-7972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-473-1320",
            "fax_number": "631-686-7972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T. MATHER MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "WISNOSKI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "631-473-1320"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 4, 2023; 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.