Active NPI
Mariam M Kirvalidze, DO
- Family Medicine Physician
- East Setauket, NY
National Provider Identifier
1508353517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 310737
- Practice address
- 181 N Belle Mead Rd Ste 2
East Setauket, NY 11733-3495 - Phone
- (631) 444-5858
- Fax
- (631) 444-1899
- NPI assigned
- Apr 16, 2018
- Last updated
- Sep 25, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 310737 | NY | Primary |
Addresses
Primary practice location
181 N Belle Mead Rd Ste 2
East Setauket, NY 11733-3495
Mailing address
1033 Northern Blvd
Roslyn, NY 11576-1502
Phone (516) 473-0782
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
- Family Practice
- Education
- New York College of Osteo Medicine of New York Institute of Technology, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5858
101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5858
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 310737 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stony Brook Family and Preventive Medicine, University Faculty Practic | Family Medicine | Current | Accepting new patients |
Locations
181 N Belle Mead Rd
Ste 2
Setauket, NY 11733
Phone (631) 444-5858
100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Stony Brook, NY
- NPI 1982659470
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
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": "1523836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664064000000",
"number": "1508353517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1033 NORTHERN BLVD",
"city": "ROSLYN",
"state": "NY",
"postal_code": "115761502",
"telephone_number": "516-473-0782",
"fax_number": "516-253-2150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "181 N BELLE MEAD RD STE 2",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "117333495",
"telephone_number": "631-444-5858",
"fax_number": "631-444-1899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRVALIDZE",
"first_name": "MARIAM",
"middle_name": "M",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-16",
"last_updated": "2022-09-25",
"certification_date": "2022-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "310737",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Setauket, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.