NPIMap

Individual provider Active NPI

Michele L Degraw, NP

  • Adult Health Nurse Practitioner
  • Stony Brook, NY
National Provider Identifier
1477975845
Registry record updated Oct 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F306689-1 Issued in NY
Practice address
HSC T15-040
Stony Brook, NY 11794-4413
Phone
(631) 638-0910
Fax
(631) 638-0915
NPI assigned
Jan 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F306689-1 NY Primary

Addresses

Primary practice location

HSC T15-040
Stony Brook, NY 11794-4413

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988
Phone (631) 444-0650

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
I20171212001631 NY Practitioner - Nurse Practitioner 7517225907 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stony Brook Internists University Faculty Practice CorporationGroup PAC ID 9133019821, 427 clinicians

Practice addresses (Care Compare)

3 Edmond D Pellegrino Rd
Stony Brook, NY 11794-9447
Phone (631) 638-1000

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F306689-1NYMDAdult Health Nurse Practitioner

Practice roles (3 of 7)

OrganizationSpecialtyStatusNew patients
University Hospital at Stony Brook Current Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Dec 1, 2017 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Dec 1, 2017 Accepting new patients

Locations

26 Research Way
East Setauket, NY 11733
Phone (631) 444-0502

Lauterbur Dr Level 5
Rm 5M0203
Stony Brook, NY 11794

3 Edmund D Pellegrino Rd
Stony Brook, NY 11794
Phone (631) 638-0800

Networks

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

Interoperability endpoints

  • Direct secure messaging: michele.degraw@direct.stonybrookmedicine.edu

Organizations & group practices 6

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 6

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": "1390176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509062400000",
    "number": "1477975845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1554",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900988",
            "telephone_number": "631-444-0650",
            "fax_number": "631-638-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HSC T15-040",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117944413",
            "telephone_number": "631-638-0910",
            "fax_number": "631-638-0915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGRAW",
        "first_name": "MICHELE",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-20",
        "last_updated": "2017-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F306689-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.