Organization Active NPI

Island Primary Medical Care Associates PC

  • Internal Medicine Physician
  • Massapequa, NY
National Provider Identifier
1487692083
Registry record updated Dec 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
166537 Issued in NY
Legal business name
ISLAND PRIMARY MEDICAL CARE ASSOCIATES PC
Practice address
4625 Merrick Rd
Massapequa, NY 11758-6010
Phone
(516) 798-1116
Fax
(516) 798-8530
NPI assigned
Jun 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2010

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

Authorized official

Name
Joseph AdiyodyNPI 1568491868
Title
Partner
Phone
(516) 798-1116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 166537 NY Primary

Addresses

Primary practice location

4625 Merrick Rd
Massapequa, NY 11758-6010

Mailing address

PO Box 9461
Uniondale, NY 11555-9461

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110222001177 NY Part B Supplier - Clinic/Group Practice 3173412418 Receives reassigned benefits from 6 practitioners
Practice locations: Babylon, NY; Massapequa, NY; Wantagh, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0874697Island Primary Medical Care PC4625 Merrick Road, Massapequa, NY 11758AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

4625 Merrick Rd
Massapequa, NY 11758
Phone (516) 798-1116

3541 Jerusalem Ave
Wantagh, NY 11793
Phone (516) 763-3000

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292544000000",
    "number": "1487692083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9461",
            "city": "UNIONDALE",
            "state": "NY",
            "postal_code": "115559461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 MERRICK RD",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117586010",
            "telephone_number": "516-798-1116",
            "fax_number": "516-798-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND PRIMARY MEDICAL CARE ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2010-12-17",
        "status": "A",
        "authorized_official_last_name": "ADIYODY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "516-798-1116"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "166537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massapequa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.