NPIMap

Organization Active NPI

Brookhaven Memorial Hospital Medical Center, Inc.

Doing business as Long Island Community Hospital

  • Physician Assistant
  • Patchogue, NY
National Provider Identifier
1487843090
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.
Doing business as
Long Island Community Hospital
Practice address
101 Hospital Road
Patchogue, NY 11772-4870
Phone
(631) 654-7755
Fax
(631) 687-2822
NPI assigned
Oct 19, 2007
Last updated
Nov 6, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BROOKHAVEN MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Authorized official

Name
Brenda J Farrell
Title
Vice President & Cfo
Phone
(631) 654-7175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

101 Hospital Road
Patchogue, NY 11772-4870

Mailing address

101 Hospital Road
Patchogue, NY 11772-4870
Phone (631) 654-7100

Other names 1

  • Long Island Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031218000695 NY Part B Supplier - Clinic/Group Practice 9739090051 Receives reassigned benefits from 113 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, NY; Westhampton, NY; Shirley, NY; Patchogue, NY; Hauppauge, NY; East Patchogue, NY; Brookhaven, NY; Bellport, NY

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Brookhaven Emer Med Ass

Practitioners & affiliated clinicians

Practitioners 46

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.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1487843090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL ROAD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-654-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL ROAD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-654-7755",
            "fax_number": "631-687-2822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKHAVEN MEMORIAL HOSPITAL",
        "enumeration_date": "2007-10-19",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "631-654-7175"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Long Island Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Patchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.