NPIMap

Individual provider Active NPI

Glen Thomas Granati, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
National Provider Identifier
1467872739
Registry record updated Sep 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
302485 Issued in NY
Practice address
Mather Hospital, 75 N Country Rd
Port Jefferson, NY 11777
Phone
(631) 473-1320
NPI assigned
Apr 24, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 302485 NY Primary
Pulmonary Disease Physician 207RP1001X 302485 NY

Addresses

Primary practice location

Mather Hospital, 75 N Country Rd
Port Jefferson, NY 11777

Mailing address

Mather Hospital, 75 North Country Rd
Intensivist Department
Port Jefferson, NY 11777
Phone (631) 473-1320

Other practice location 1

Dept. of Medicine, HSC Level 16, SUNY Stony Brook
Stony Brook, NY 11794
Phone (631) 444-7411

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
I20200917002215 NY Practitioner - Critical Care (Intensivists)Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 4486993441 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Pulmonary Disease
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
John T Mather Memorial HospitalGroup PAC ID 1254237753, shared by 6 NPIs, 176 clinicians

Practice addresses (Care Compare)

21 Reade PL
Suite 1000
Poughkeepsie, NY 12601-3950
Phone (845) 214-1821

75 N Country Rd
Port Jefferson, NY 11777-2119
Phone (631) 473-1320

7901 Broadway
Elmhurst, NY 11373-1329

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
John T. Mather Memorial Hospital Current Accepting new patients
North Shore-Lij Medical PC CurrentSince Jan 19, 2021 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Nov 11, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Nov 11, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
John T Mather Memorial Hospital CurrentSince Sep 8, 2020 Accepting new patients
John T. Mather Memorial Hospital Critical Care Medicine CurrentSince Sep 8, 2020 Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients

Locations

7901 Broadway
Rm A119
Elmhurst, NY 11373
Phone (718) 334-4951

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

300 Community Dr
Manhasset, NY 11030

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

125 Oakland Ave
Ste 204
Port Jefferson, NY 11777
Phone (631) 686-1400

75 N Country Rd
Ste 201
Prt Jefferson, NY 11777
Phone (631) 686-2575

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

Networks

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

Interoperability endpoints

  • Direct secure messaging: ggranati843709@nychhc.direct-ci.com

Organizations & group practices 9

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.

Hospital & facility affiliations 4

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": "1398297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1467872739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MATHER HOSPITAL, 75 NORTH COUNTRY RD",
            "address_2": "INTENSIVIST DEPARTMENT",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "11777",
            "telephone_number": "631-473-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MATHER HOSPITAL, 75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "11777",
            "telephone_number": "631-473-1320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Dept. of Medicine, HSC Level 16, SUNY Stony Brook",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "11794",
            "country_code": "US",
            "telephone_number": "631-444-7411",
            "fax_number": "631-444-2493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRANATI",
        "first_name": "GLEN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-24",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NY",
            "license": "302485",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "302485",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.