Active NPI
Saad A Shukri, M.D.
- Specialist
- East Patchogue, NY
National Provider Identifier
1487726584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 211205
- Practice address
- 629 Route 112 Ste 8
East Patchogue, NY 11772-1335 - Phone
- (631) 447-8697
- Fax
- (631) 447-0913
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 211205 | NY | Primary |
Addresses
Primary practice location
629 Route 112 Ste 8
East Patchogue, NY 11772-1335
Mailing address
629 Route 112 Ste 8
East Patchogue, NY 11772-1335
Phone (631) 447-8697
Other practice location 1
286 Sills Rd Ste 3
East Patchogue, NY 11772-8810
Phone (631) 447-8697
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02011287 | Medicaid | NY |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- Other, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- John T Mather Memorial Hospital
Practice addresses (Care Compare)
5225-53 Route 347
Building 12
Port Jefferson Station, NY 11777-2054
Phone (631) 474-4590
75 N Country Rd
Port Jefferson, NY 11777-2119
Phone (631) 473-1320
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 307 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John T. Mather Memorial Hospital | Current | Accepting new patients | |
| John T Mather Memorial Hospital | Current | Accepting new patients |
Locations
100 Highlands Blvd
#9
Port Jefferson, NY 11777
Phone (631) 686-7809
75 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 463-1320
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- Port Jefferson, NY
- NPI 1750740437
-
- Critical Care Medicine (Internal Medicine) Physician
- Port Jefferson, NY
- NPI 1467249334
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Port Jefferson, NY
- NPI 1093718728
-
dba Stony Brook Southampton Hospital
- General Acute Care Hospital
- Southampton, NY
- NPI 1033224704
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1225507114
-
- General Acute Care Hospital
- Greenport, NY
- NPI 1881690691
-
- General Acute Care Hospital
- Stony Brook, NY
- NPI 1972523348
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651449600000",
"number": "1487726584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "629 ROUTE 112 STE 8",
"city": "EAST PATCHOGUE",
"state": "NY",
"postal_code": "117721335",
"telephone_number": "631-447-8697",
"fax_number": "631-447-0913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "629 ROUTE 112 STE 8",
"city": "EAST PATCHOGUE",
"state": "NY",
"postal_code": "117721335",
"telephone_number": "631-447-8697",
"fax_number": "631-447-0913"
}
],
"practiceLocations": [
{
"address_1": "286 Sills Rd Ste 3",
"address_purpose": "LOCATION",
"city": "East Patchogue",
"state": "NY",
"postal_code": "117728810",
"country_code": "US",
"telephone_number": "631-447-8697",
"fax_number": "631-447-0913",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHUKRI",
"first_name": "SAAD",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2022-05-02",
"certification_date": "2022-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "211205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02011287",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Patchogue, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.