NPIMap

Organization Active NPI

Central Suffolk Hospital

Doing business as Peconic Bay Medical Center

  • General Acute Care Hospital
  • Riverhead, NY
National Provider Identifier
1386649804
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
5155000H Issued in NY
Legal business name
CENTRAL SUFFOLK HOSPITAL
Doing business as
Peconic Bay Medical Center
Practice address
1300 Roanoke Ave
Riverhead, NY 11901-2031
Phone
(631) 548-6000
Fax
(631) 548-6007
NPI assigned
Jun 21, 2005
Last updated
Jul 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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

Authorized official

Name
Mrs. Michele L Cusack
Title
Senior Vice President & Cfo
Phone
(516) 321-6508

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
General Acute Care Hospital 282N00000X 5155000H NY Primary

Addresses

Primary practice location

1300 Roanoke Ave
Riverhead, NY 11901-2031

Mailing address

1300 Roanoke Ave
Riverhead, NY 11901-2031
Phone (631) 548-6000

Other names 1

  • Peconic Bay Medical Center Doing business as

Electronic endpoints 3

TypeEndpointUseAffiliation
FHIR URL https://fhir-myrecord.cerner.com/dstu2 Health Information Exchange (HIE)
CONNECT URL https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark
Direct Messaging Address direct@direct.toc.pbmchealth.org Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060914000038 NY Part A Provider - Hospital 4981508082 Practice locations: Riverhead, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386649804. Details of each certification follow.

Hospital certification: CCN 330107

Legal name
CENTRAL SUFFOLK HOSPITAL
Doing business as
PECONIC BAY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 26, 2023
Beds
122
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Jun 26, 1945 in NY
Enrollment address
1 Heroes Way
Riverhead, NY 11901-2054
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Peconic Bay Medical CenterCCN 330107 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0008773Peconic Bay Medical Center Laboratory1 Heroes Way, Riverhead, NY 11901ComplianceMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Central Suffolk Hosp P4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

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

Interoperability endpoints

  • Direct secure messaging: direct@direct.toc.pbmchealth.org

Ownership & related parties

All disclosed owners & managing parties 25

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William L Mack Individual Corporate Officer Jan 1, 2025
Margaret M Crotty Individual Corporate Officer Jan 1, 2025
Northwell, Inc. Organization, Westbury, NY Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2024
Harry E Gindi Individual Corporate Officer Jan 1, 2025
Jeffrey a Kraut Individual Corporate Officer Jan 1, 2025
Robert D Rosenthal Individual Corporate Officer Jan 1, 2025
Mark L Claster Individual Corporate Officer Jan 1, 2025
Brian Lally Individual Corporate Officer Jan 1, 2025
Mark J Solazzo Individual Corporate Officer Jan 1, 2025
Richard D Goldstein Individual Corporate Officer Jan 1, 2025
Northwell Healthcare Inc Organization, Westbury, NY Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2015 100%
David L Battinelli Individual Corporate Officer Jan 1, 2025
Donald Zucker Individual Corporate Officer Jan 1, 2025
Barry Rubenstein Individual Corporate Officer Jan 1, 2025
Northwell Health Inc Organization, Westbury, NY Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2015
Michael a Epstein Individual Corporate Officer Jan 1, 2025
Mark a. Gloade Individual Corporate Officer Jan 1, 2025
John K D'Angelo Individual Corporate Officer Jan 1, 2025
Donna K Drummond Individual Corporate Officer Jan 1, 2025
Michael J Dowling Individual Corporate Officer Jan 1, 2025
Laurence a Kraemer Individual Corporate Officer Jan 1, 2025
Konstantine Costalas Individual Corporate Officer Jan 1, 2025
Ralph a Nappi Individual Corporate Officer Jan 1, 2025
Kevin Beiner Individual Corporate Officer Jan 1, 2025
Michele L Cusack Individual Corporate Officer Sep 12, 2017
W-2 Managing Employee Sep 12, 2017

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 42

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 42

Practitioners & affiliated clinicians

Practitioners 65

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 65

Affiliated clinicians 470

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 470

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1386649804",
    "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": "631-548-6000",
            "fax_number": "631-548-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012031",
            "telephone_number": "631-548-6000",
            "fax_number": "631-548-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL SUFFOLK HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "516-321-6508",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NY",
            "license": "5155000H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir-myrecord.cerner.com/dstu2",
            "affiliation": "N",
            "endpointDescription": "Peconic Bay Medical Center FHIR API",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1300 Roanoke Ave",
            "city": "Riverhead",
            "state": "NY",
            "country_code": "US",
            "postal_code": "119012031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "Bluemark",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611036",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.toc.pbmchealth.org",
            "affiliation": "N",
            "endpointDescription": "Peconic Bay Medical Center Cerner Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1300 Roanoke Ave",
            "city": "Riverhead",
            "state": "NY",
            "country_code": "US",
            "postal_code": "119012031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Peconic Bay Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peconic Bay Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverhead, NY

Sources for this page

Verify at the official NPI Registry.