NPIMap

Individual provider Active NPI

Jerry Ninia, M.D.

  • Obstetrics & Gynecology Physician
  • Port Jefferson Station, NY
National Provider Identifier
1457350795
Registry record updated Apr 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
174810 Issued in NY
Practice address
4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363
Phone
(631) 331-0500
Fax
(631) 331-1644
NPI assigned
Jul 19, 2005
Reactivated
Mar 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 174810 NY Primary
Phlebology Physician 202K00000X 174810 NY

Addresses

Primary practice location

4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363

Mailing address

4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363
Phone (631) 331-0500

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
I20110114000736 NY Practitioner - Obstetrics/GynecologyPractitioner - Other (Physician) 7810186236 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 1987
Medicare assignment
May accept Medicare assignment
Group practices
Square Care Medical Group LLPGroup PAC ID 7012938434, 70 clinicians

Practice addresses (Care Compare)

4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363
Phone (631) 331-0500

405 E Main St
Port Jefferson, NY 11777-1868
Phone (631) 474-1414

Hospital & facility affiliations

  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

Merit-based Incentive Payment System (MIPS)

Final score
87.62 of 100Reported as group
Quality
88.76
Promoting interoperability
100
Improvement activities
40
Cost
69.99

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal153
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
174810NYMDPhlebology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Square Care Medical Group, LLP Obstetrics & Gynecology CurrentSince Mar 15, 2016 Accepting new patients
St Charles Hospital Corp Past Accepting new patients

Locations

191 Herricks Rd
New Hyde Park, NY 11040
Phone (516) 248-0144

4 Roosevelt Ave
Port Jefferson Station, NY 11776
Phone (631) 331-0500

Interoperability endpoints

  • Direct secure messaging: jerry.ninia.1@15987.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15987/brand/1/csg/1/fhir/r4

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 9

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": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493251200000",
    "number": "1457350795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 ROOSEVELT AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763363",
            "telephone_number": "631-331-0500",
            "fax_number": "631-331-1644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 ROOSEVELT AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763363",
            "telephone_number": "631-331-0500",
            "fax_number": "631-331-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NINIA",
        "first_name": "JERRY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2017-04-27",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "174810",
            "primary": true
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "NY",
            "license": "174810",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.