Individual provider Active NPI

Michael Joseph Michno Jr., MD

  • Diagnostic Radiology Physician
  • Port Jefferson, NY
National Provider Identifier
1407351182
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
35.152557 Issued in OH
Practice address
75 N Country Rd
Port Jefferson, NY 11777-2119
Phone
(631) 686-2517
NPI assigned
Mar 26, 2018
Last updated
Feb 19, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 35.152557 OH Primary

Addresses

Primary practice location

75 N Country Rd
Port Jefferson, NY 11777-2119

Mailing address

141 Pleasant St # 1
Boston, MA 02125-1525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240612003962 CA Practitioner - Diagnostic Radiology 3678803640 Reassigns benefits to 6 organizations
I20251226000527 OH Practitioner - Diagnostic Radiology 3678803640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Tufts University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Network Radiologists IncGroup PAC ID 7618960303, 74 clinicians

Practice addresses (Care Compare)

338 Spear St
Unit 41E
San Francisco, CA 94105-6165
Phone (937) 395-8627

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.33 of 100Reported as group
Quality
77.37
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
90.67 of 100Reported as group
Quality
84.1
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.152557OHMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Nov 14, 2024 Accepting new patients
Bay Imaging Consultants Medical Group Inc Diagnostic Radiology CurrentSince Jun 24, 2024 Accepting new patients
Kettering Network Radiologists Inc Diagnostic Radiology CurrentSince Mar 1, 2025 Accepting new patients
Bay Imaging Consultants Medical Group Inc Diagnostic Radiology Current Accepting new patients
Henry County Hospital Inc CurrentSince Oct 31, 2025 Accepting new patients
Magnetic Imaging Affiliates, LLC Diagnostic Radiology CurrentSince Jun 24, 2024 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Nov 14, 2024 Accepting new patients
County of Santa Clara Current Accepting new patients
Bay Imaging Consultants Medical Group Inc Diagnostic Radiology CurrentSince Jun 24, 2024 Accepting new patients
County of Santa Clara CurrentSince Nov 14, 2024 Accepting new patients
County of Santa Clara CurrentSince Nov 14, 2024 Accepting new patients
John Muir Call Coverage Medical Group, Inc. Past Accepting new patients
Northbay Healthcare Group Past Accepting new patients

Locations (25 of 27)

3901 Lone Tree Way
Antioch, CA 94509
Phone (925) 779-7200

2001 Dwight Way
Berkeley, CA 94704
Phone (510) 204-1880

2400 Balfour Rd
Brentwood, CA 94513
Phone (925) 308-8100

2540 East St
Concord, CA 94520
Phone (925) 674-2228

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

15400 National Ave
Ste 200
Los Gatos, CA 95032
Phone (408) 358-8414

3100 Summit St
Oakland, CA 94609
Phone (510) 869-8377

350 Hawthorne Ave
Oakland, CA 94609
Phone (510) 655-4000

5730 Telegraph Ave
Oakland, CA 94609
Phone (510) 204-1507

12 Camino Encinas
Orinda, CA 94563
Phone (510) 204-8180

140 Brookwood Rd
Ste 100
Orinda, CA 94563
Phone (925) 254-9090

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

225 N Jackson Ave
San Jose, CA 95116
Phone (408) 347-4051

2425 Samaritan Dr
San Jose, CA 95124
Phone (408) 354-2114

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

300 Hospital Dr
#1112
Vallejo, CA 94589
Phone (707) 554-4107

1450 Treat Blvd
Walnut Creek, CA 94597
Phone (925) 308-8299

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

Interoperability endpoints

  • Direct secure messaging: mmichno683874@hisp.ehr.sutterhealth.org

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1407351182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 PLEASANT ST # 1",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021251525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-686-2517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHNO",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-26",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "35.152557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.