Anthony C Theodoris, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

221756-1 Issued in NY

Practice address

1500 Route 112 Ste B
Port Jefferson Station, NY 11776-8054

Phone

(631) 978-7633

Fax

(631) 638-4884

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

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

Specialty

Pulmonary DiseaseAlso: Critical Care (Intensivists)

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stony Brook Internists University Faculty Practice CorporationGroup PAC ID 9133019821, 427 clinicians

Long Island Pulmonary Rehabilitation PCGroup PAC ID 0941569529, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
• John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
• St Charles Hospital Inpatient rehabilitation facility, Port Jefferson, NY, CCN 33T246

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: anthony.theodoris@sbcm.cernerdirect.com
• Direct secure messaging: anthonytheodoris@spal-ny.direct.office.nextgen.com

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.

• Long Island Pulmonary Rehabilitation PC

  • Pulmonary Disease Physician
  • Huntington, NY
  • NPI 1699284281
  Medicare reassignment Care Compare group NPD Authorized official
• Stony Brook Internists, University Faculty Practice Corporation

  • Cardiac Rehabilitation Registered Nurse
  • Stony Brook, NY
  • NPI 1295778371
  Medicare reassignment Care Compare group NPD
• 25A Medical

  • Pulmonary Disease Physician
  • Central Islip, NY
  • NPI 1225748494
  NPD Authorized official
• Stony Brook Internists, University Faculty Practice Corporation

  • Pulmonary Disease Physician
  • Stony Brook, NY
  • NPI 1104865229
  NPD
• American Diagnostics Medical PLLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Huntington, NY
  • NPI 1194985762

  Pulmonary Disease

  NPD (past)
• Stony Brook Internists, University Faculty Practice Corporation

  • Medical Oncology Physician
  • Stony Brook, NY
  • NPI 1184679342
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• John T. Mather Memorial Hospital

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1093718728
  Care Compare affiliation
• St Charles Hospital Corp

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1164481529
  Care Compare affiliation
• St Charles Hospital Corp

  • Rehabilitation Hospital Unit
  • Port Jefferson, NY
  • NPI 1225097652

  Inpatient rehabilitation facility

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1578675971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 RESEARCH WAY STE 208A",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117336401",
            "telephone_number": "631-675-2125",
            "fax_number": "631-675-2628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112 STE B",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768054",
            "telephone_number": "631-978-7633",
            "fax_number": "631-638-4884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODORIS",
        "first_name": "ANTHONY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "221756-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE OTHER PIN",
            "identifier": "7V691EC831",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02732167",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "atheodoris@nsc.direct.gemmsnest.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1500 Route 112 Ste B",
            "city": "Port Jefferson Station",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117768054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pulmonary Disease Physician in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Pulmonary Disease Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.

Verify at the official NPI Registry.