Guillermo A. San Roman, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

150903 Issued in NY

Practice address

1630 Deer Park Ave
Deer Park, NY 11729-5210

Phone

(631) 242-6166

Fax

(631) 242-8768

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Cardiovascular Disease (Cardiology)Also: Internal Medicine

Education

Pennsylvania State University College of Medicine, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore - Lij Cardiology at Deer Park PCGroup PAC ID 4486879418, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• NS/Lij HS Southside Hospital Hospital, Bay Shore, NY, CCN 330043
• Good Samaritan Hospital Medical Center Hospital, West Islip, NY, CCN 330286
• North Shore University Hospital Hospital, Manhasset, NY, CCN 330106
• Peconic Bay Medical Center Hospital, Riverhead, NY, CCN 330107
• John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Networks

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

Interoperability endpoints

• Direct secure messaging: guillermosanroman@nslijmedgr.allscriptsdirect.net

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.

• North Shore - Lij Cardiology at Deer Park PC

  • Cardiovascular Disease Physician
  • Deer Park, NY
  • NPI 1972941953
  Medicare reassignment Care Compare group
• Cardiac Ekg Interpretation, P. C.

  • Cardiovascular Disease Physician
  • West Islip, NY
  • NPI 1386665644
  Medicare reassignment

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

• Central Suffolk Hospital

  • General Acute Care Hospital
  • Riverhead, NY
  • NPI 1386649804
  Care Compare affiliation
• Good Samaritan Hospital Medical Center

  • General Acute Care Hospital
  • West Islip, NY
  • NPI 1902865355
  Care Compare affiliation
• John T. Mather Memorial Hospital

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1093718728
  Care Compare affiliation
• North Shore University Hospital

  • General Acute Care Hospital
  • Manhasset, NY
  • NPI 1366459570
  Care Compare affiliation
• South Shore University Hospital

  • General Acute Care Hospital
  • Bay Shore, NY
  • NPI 1457369381
  Care Compare affiliation

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484870400000",
    "number": "1386668499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 DEER PARK AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117295210",
            "telephone_number": "631-242-6166",
            "fax_number": "631-242-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 DEER PARK AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117295210",
            "telephone_number": "631-242-6166",
            "fax_number": "631-242-8768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN ROMAN",
        "first_name": "GUILLERMO",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2017-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "150903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01453130",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruben Hector Saavedra, PA-C
• Aimee Safian
• Nicole Saify
• Salvatore R, Principe, DC, PC
• Alicia Rose Sammut
• Judy Sanders-Boyd, DDS
• Lisa T Sandler, PA
• Amiah Sands
• Doreen Sang, NP
• Natascha M Santos, PSY. D.

• Cardiovascular Disease Physician in Deer Park, NY
• Providers in Deer Park, NY by specialty
• Cardiovascular Disease Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.