NPIMap

Individual provider Active NPI

Wayne Waltzer, M.D.

  • Urology Physician
  • East Setauket, NY
National Provider Identifier
1497782189
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
139086 Issued in NY
Practice address
24 Research Way
Suite 500
East Setauket, NY 11733-3453
Phone
(631) 444-6270
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 139086 NY Primary

Addresses

Primary practice location

24 Research Way
Suite 500
East Setauket, NY 11733-3453

Mailing address

PO Box 1559
Stony Brook, NY 11790-0989
Phone (631) 444-6270

Other identifiers 3

IdentifierTypeStateIssuer
00496066MedicaidNY
0388S2OtherNYEMPIRE B/C B/S
4401701OtherNYAETNA

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
I20070119000120 NY Practitioner - Urology 8325042849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Pittsburgh School of Medicine, 1973
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

24 Research Way
Suite 500
East Setauket, NY 11733-3470
Phone (631) 444-6270

P O Box
Suite 1554
Stony Brook, NY 11790-0989

PO Box
Suite 1554
Stony Brook, NY 11790-0988

Hospital & facility affiliations

  • Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
  • Centerwell Home Health Home health agency, Hauppauge, NY, CCN 337232
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection25
Removal of tissue1-10
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Urology, University Faculty Practice Corporation Urology CurrentSince Jul 1, 1983 Accepting new patients
University Hospital at Stony Brook Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

4 Smith Haven Mall
Ste 110
Lake Grove, NY 11755

24 Research Way
Ste 500
Setauket, NY 11733
Phone (631) 444-2209

Networks

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

Interoperability endpoints

  • Direct secure messaging: wayne.waltzer@direct.stonybrookmedicine.edu

Organizations & group practices 3

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 9

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": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497782189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900989",
            "telephone_number": "631-444-6270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 RESEARCH WAY",
            "address_2": "SUITE 500",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117333453",
            "telephone_number": "631-444-6270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTZER",
        "first_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "139086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00496066",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE B/C B/S",
            "identifier": "0388S2",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4401701",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

Verify at the official NPI Registry.