NPIMap

Individual provider Active NPI

John Gregg Petraco, MD

  • Obstetrics & Gynecology Physician
  • Port Jefferson, NY
National Provider Identifier
1497739064
Registry record updated Oct 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
194289 Issued in NY
Practice address
118 N Country Rd
Port Jefferson, NY 11777-2120
Phone
(631) 471-7171
Fax
(631) 473-4605
NPI assigned
Dec 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 194289 NY Primary

Addresses

Primary practice location

118 N Country Rd
Port Jefferson, NY 11777-2120

Mailing address

118 N Country Rd
Port Jefferson, NY 11777-2120
Phone (631) 471-7171

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
I20060330000168 NY Practitioner - Obstetrics/Gynecology 6608884820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
State University of New York at Stony Brook, School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Shore Hematology Oncology Associates PCGroup PAC ID 1456243641, 474 clinicians

Practice addresses (Care Compare)

217 Portion Rd
Ronkonkoma, NY 11779-2341
Phone (631) 751-3000

48 Route 25a
Smithtown, NY 11787-1431
Phone (631) 751-3000

7 S Jersey Ave
Suite 1
East Setauket, NY 11733-2065
Phone (631) 751-3000

Hospital & facility affiliations

  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • Long Island Community Hospital Hospital, Patchogue, NY, CCN 330141
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
194289NYMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Hematology Oncology Associates PC CurrentSince May 1, 2022 Accepting new patients

Locations

285 Sills Rd
Bldg 1D
East Patchogue, NY 11772

3016 30th Dr
Long Island City, NY 11102
Phone (718) 728-3376

214 E Main St
Patchogue, NY 11772

1500 Route 112
Bldg 4
Port Jefferson Station, NY 11776
Phone (631) 574-8354

118 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 376-0055

148 Terry Rd
Smithtown, NY 11787
Phone (631) 862-4000

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

Networks

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

Organizations & group practices 1

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 10

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": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318204800000",
    "number": "1497739064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772120",
            "telephone_number": "631-471-7171",
            "fax_number": "631-473-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772120",
            "telephone_number": "631-471-7171",
            "fax_number": "631-473-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRACO",
        "first_name": "JOHN",
        "middle_name": "GREGG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2011-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "194289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.