NPIMap

Individual provider Active NPI

Raja Jaber, M.D.

  • Family Medicine Physician
  • Stony Brook, NY
National Provider Identifier
1417999764
Registry record updated Apr 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
164456 Issued in NY
Practice address
2500 Nesconset Hwy
BLD 16
Stony Brook, NY 11790-2555
Phone
(631) 444-6250
Fax
(631) 444-6665
NPI assigned
Jun 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2014

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 164456 NY Primary

Addresses

Primary practice location

2500 Nesconset Hwy
BLD 16
Stony Brook, NY 11790-2555

Mailing address

PO Box 1559
Stony Brook, NY 11790-0989
Phone (631) 444-6250

Other identifiers 3

IdentifierTypeStateIssuer
4307709OtherNYAETNA
47F501OtherNYEMPIRE BC.BS
01052184MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070109000277 NY Practitioner - Family Practice 8224038609 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5858

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5858

Hospital & facility affiliations

  • Tender Loving Care, an Amedisys Company Home health agency, Medford, NY, CCN 337260
  • Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
  • Centerwell Home Health Home health agency, Hauppauge, NY, CCN 337232
  • Peconic Bay Homehealth Services Home health agency, Riverhead, NY, CCN 337400
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Family and Preventive Medicine, University Faculty Practic Family Medicine CurrentSince Jan 1, 2017 Accepting new patients
University Hospital at Stony Brook Current Accepting new patients
Stony Brook Children'S Service, University Faculty Practice Corporatio Past Accepting new patients
Neurology Associates of Stony Brook, University Faculty Practice Corpo Past Accepting new patients

Locations

33 Research Way
Setauket, NY 11733
Phone (631) 444-0624

2500 Nesconset Hwy
Bldg 16
Stony Brook, NY 11790
Phone (631) 444-6250

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Interoperability endpoints

  • Direct secure messaging: raja.jaber1@direct.stonybrookmedicine.edu

Organizations & group practices 4

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 12

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398038400000",
    "number": "1417999764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900989",
            "telephone_number": "631-444-6250",
            "fax_number": "631-444-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NESCONSET HWY",
            "address_2": "BLD 16",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117902555",
            "telephone_number": "631-444-6250",
            "fax_number": "631-444-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JABER",
        "first_name": "RAJA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2014-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "164456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4307709",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC.BS",
            "identifier": "47F501",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01052184",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.