Individual provider Active NPI

Lewis Lee Bateman, MD

  • Family Medicine Physician
  • Port Jefferson, NY
National Provider Identifier
1396749669
Registry record updated Oct 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
124006 Issued in NY
Practice address
125 Oakland Ave Suite 205
Mather Primary Care
Port Jefferson, NY 11777
Phone
(631) 686-2523
Fax
(631) 686-2525
NPI assigned
Jun 2, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 124006 NY Primary

Addresses

Primary practice location

125 Oakland Ave Suite 205
Mather Primary Care
Port Jefferson, NY 11777

Mailing address

125 Oakland Ave Suite 205
Mather Primary Care
Port Jefferson, NY 11777
Phone (631) 686-2523

Other identifiers 1

IdentifierTypeStateIssuer
00349642MedicaidNY

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20091230000077 NY Practitioner - Family PracticePractitioner - Geriatric Medicine 6406996289 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
124006NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harbor View Medical Services PC CurrentSince Jan 1, 2015 Accepting new patients
Harbor View Medical Services PC CurrentSince Jan 1, 2015 Accepting new patients
Harbor View Medical Services PC Current Accepting new patients

Locations

125 Oakland Ave
Ste 205
Port Jefferson, NY 11777
Phone (631) 686-2523

625 Belle Terre Rd
Ste 100
Prt Jefferson, NY 11777
Phone (631) 686-7603

70 N Country Rd
Ste 101
Prt Jefferson, NY 11777
Phone (631) 473-0037

Interoperability endpoints

  • Direct secure messaging: lewis.bateman.1@7759.direct.athenahealth.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.

NPI Registry JSON

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

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382572800000",
    "number": "1396749669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 OAKLAND AVE SUITE 205",
            "address_2": "MATHER PRIMARY CARE",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "11777",
            "telephone_number": "631-686-2523",
            "fax_number": "631-686-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 OAKLAND AVE SUITE 205",
            "address_2": "MATHER PRIMARY CARE",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "11777",
            "telephone_number": "631-686-2523",
            "fax_number": "631-686-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BATEMAN",
        "first_name": "LEWIS",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-02",
        "last_updated": "2013-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "124006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00349642",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.