Individual provider Active NPI

Spencer Alvarado, PA

  • Physician Assistant
  • East Setauket, NY
National Provider Identifier
1427833631
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
030523 Issued in NY
Practice address
45 Research Way Ste 108
East Setauket, NY 11733-6401
Phone
(631) 941-2000
NPI assigned
Aug 28, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 030523 NY Primary

Addresses

Primary practice location

45 Research Way Ste 108
East Setauket, NY 11733-6401

Mailing address

47 Upton Dr
Sound Beach, NY 11789-2133

Other practice location 1

75 N Country Rd
Port Jefferson, NY 11777-2190
Phone (631) 473-1320

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240506003966 NY Practitioner - Physician Assistant 5496195521 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
030523NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Mar 23, 2024 Accepting new patients
John T. Mather Memorial Hospital CurrentSince Apr 15, 2024 Accepting new patients
John T. Mather Memorial Hospital CurrentSince Apr 15, 2024 Accepting new patients

Locations

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

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

75 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 463-1320

45 Research Way
Ste 108
Setauket, NY 11733
Phone (631) 941-2704

Networks

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1693180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1427833631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 UPTON DR",
            "city": "SOUND BEACH",
            "state": "NY",
            "postal_code": "117892133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 RESEARCH WAY STE 108",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117336401",
            "telephone_number": "631-941-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 N Country Rd",
            "address_purpose": "LOCATION",
            "city": "Port Jefferson",
            "state": "NY",
            "postal_code": "117772190",
            "country_code": "US",
            "telephone_number": "631-473-1320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALVARADO",
        "first_name": "SPENCER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "030523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

Verify at the official NPI Registry.