Individual provider Active NPI

Michael Paluch

  • Registered Nurse
  • Bay Shore, NY
National Provider Identifier
1417620642
Registry record updated Jul 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
315984 Issued in NC
Practice address
301 E Main St
Bay Shore, NY 11706-8408
Phone
(631) 968-3000
NPI assigned
Jul 25, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 315984 NC Primary

Addresses

Primary practice location

301 E Main St
Bay Shore, NY 11706-8408

Mailing address

107 W Court Dr
Centereach, NY 11720-2327
Phone (631) 513-6136

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211209000187 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 0244620060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Wake Forest University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore - Lij Anesthesiology, PCGroup PAC ID 1153602453, 990 clinicians

Practice addresses (Care Compare)

240 Jericho Tpke
Syosset, NY 11791-4504
Phone (516) 517-5300

Hospital & facility affiliations

  • NS/Lij HS Southside Hospital Hospital, Bay Shore, NY, CCN 330043

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
315984NCMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Anesthesiology, PC CurrentSince Sep 21, 2021 Accepting new patients

Locations

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

195 E Main St
Huntington, NY 11743
Phone (631) 385-8677

240 Jericho Tpke
Syosset, NY 11791
Phone (516) 497-7900

Networks

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

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1627171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627171200000",
    "number": "1417620642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 W COURT DR",
            "city": "CENTEREACH",
            "state": "NY",
            "postal_code": "117202327",
            "telephone_number": "631-513-6136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068408",
            "telephone_number": "631-968-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALUCH",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-25",
        "last_updated": "2021-07-25",
        "certification_date": "2021-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "315984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.