Individual provider Active NPI

Mickel L Khlat, DO

  • Internal Medicine Physician
  • Smithtown, NY
National Provider Identifier
1548288954
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
228341 Issued in NY
Practice address
267 E Main St BLDG a
Smithtown, NY 11787-2850
Phone
(631) 758-7003
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 228341 NY Primary

Addresses

Primary practice location

267 E Main St BLDG a
Smithtown, NY 11787-2850

Mailing address

1 Research Rd
Ridge, NY 11961-2701
Phone (631) 751-3000

Other identifiers 1

IdentifierTypeStateIssuer
02666562MedicaidNY

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050811001023 NY Practitioner - Geriatric MedicinePractitioner - Internal MedicinePractitioner - Hospitalist 2860421591 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Internal Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2000
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)

1500 Route 112
Port Jefferson Station, NY 11776-8054
Phone (631) 751-3000

365 E Main St
Patchogue, NY 11772-3145
Phone (631) 751-3000

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

Hospital & facility affiliations

  • Peconic Bay Homehealth Services Home health agency, Riverhead, NY, CCN 337400
  • Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

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 Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Hematology Oncology Associates PC CurrentSince May 1, 2024 Accepting new patients
St. Catherine of Siena Medical Center CurrentSince Dec 15, 2018 Accepting new patients
Southwest Suffolk Medical PC CurrentSince Jan 1, 2016 Accepting new patients
Southwest Suffolk Medical, P.C. CurrentSince Jan 1, 2016 Accepting new patients
Qlimg Rochdale Village OB/GYN Office Internal Medicine Past Accepting new patients

Locations

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

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

300 Bay Shore Rd
North Babylon, NY 11703
Phone (631) 586-2700

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

1 Research Rd
Ridge, NY 11961

640 Hawkins Ave
Ronkonkoma, NY 11779
Phone (631) 737-0100

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

267 E Main St
Bldg A
Smithtown, NY 11787
Phone (631) 724-2000

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

6279 Route 25A
Wading River, NY 11792
Phone (631) 758-7003

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

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

Interoperability endpoints

  • Direct secure messaging: mkhlat15431@direct-chsli.net

Organizations & group practices 5

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1548288954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RESEARCH RD",
            "city": "RIDGE",
            "state": "NY",
            "postal_code": "119612701",
            "telephone_number": "631-751-3000",
            "fax_number": "631-751-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 E MAIN ST BLDG A",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872850",
            "telephone_number": "631-758-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHLAT",
        "first_name": "MICKEL",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "228341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02666562",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

Verify at the official NPI Registry.