NPIMap

Individual provider Active NPI

Edward J Kormylo, DPM

  • Foot Surgery Podiatrist
  • Patchogue, NY
National Provider Identifier
1568436392
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
N003100 Issued in NY
Practice address
33 Medford Ave Ste D
Patchogue, NY 11772-1222
Phone
(631) 687-4190
Fax
(631) 687-4199
NPI assigned
Feb 16, 2006
Last updated
Oct 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery Podiatrist 213ES0131X N003100 NY Primary

Addresses

Primary practice location

33 Medford Ave Ste D
Patchogue, NY 11772-1222

Mailing address

14 Wall St FL 9
New York, NY 10005-2178

Other identifiers 2

IdentifierTypeStateIssuer
00588743MedicaidNY
480015120OtherNYMEDICARE RAILROAD

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
I20100621000047 NY Practitioner - Podiatry 2466582325 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

157 E Woodside Ave
Patchogue, NY 11772-1423
Phone (631) 475-1900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue614
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
003100NYMDHospitalist Physician
N003100NYMDFoot Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Nov 6, 2022 Accepting new patients
New York University CurrentSince Nov 6, 2022 Accepting new patients
Brookhaven Memorial Hospital Medical Center, Inc. Current Accepting new patients
Brookhaven Memorial Hospital Medical Center CurrentSince Dec 1, 2021 Accepting new patients
East Patchogue Podiatry P.C. Foot Surgery CurrentSince May 15, 1995 Accepting new patients
Long Island Community Hospital at NYU Langone Health CurrentSince Dec 1, 2021 Accepting new patients

Locations

285 Sills Rd
Bldg 15
East Patchogue, NY 11772

285 Sills Rd
Bldg 17
East Patchogue, NY 11772
Phone (631) 654-5566

285 Sills Rd
Bldg 5-6H
East Patchogue, NY 11772
Phone (631) 438-0777

300 Kennedy Dr
Hauppauge, NY 11788
Phone (631) 227-6650

157 E Woodside Ave
Patchogue, NY 11772
Phone (631) 265-7000

33 Medford Ave
Ste D
Patchogue, NY 11772
Phone (631) 687-4190

33 Medford Ave
Ste E
Patchogue, NY 11772
Phone (631) 207-4200

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

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

Interoperability endpoints

  • Direct secure messaging: ekormylo509453@nyumc.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 11

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": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1568436392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 WALL ST FL 9",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100052178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 MEDFORD AVE STE D",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721222",
            "telephone_number": "631-687-4190",
            "fax_number": "631-687-4199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORMYLO",
        "first_name": "EDWARD",
        "middle_name": "J",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-16",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "N003100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00588743",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "480015120",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Patchogue, NY

Sources for this page

Verify at the official NPI Registry.