Individual provider Active NPI

Sushma Kapur, PA

  • Physician Assistant
  • Stony Brook, NY
National Provider Identifier
1609817949
Registry record updated Nov 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
008075 Issued in NY
Practice address
100 Nicolls Rd # Level4
Stony Brook, NY 11790-3407
Phone
(631) 638-4170
Fax
(631) 638-4179
NPI assigned
Jun 9, 2006
Last updated
Nov 9, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 008075 NY Primary

Addresses

Primary practice location

100 Nicolls Rd # Level4
Stony Brook, NY 11790-3407

Mailing address

PO Box 1559
Stony Brook, NY 11790-0989
Phone (631) 444-0650

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040108000132 NY Practitioner - Physician Assistant 3476452418 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
South Shore University Hospital CurrentSince Oct 23, 2000 Accepting new patients
Brookhaven Memorial Hospital Medical Center Past Accepting new patients
New York Spine & Brain Surgery, University Faculty Practice Corporatio Past Accepting new patients
Stony Brook Radiology, University Faculty Practice Corporation Past Accepting new patients
Emergency Medicine Physicians of Suffolk County, PLLC Past Accepting new patients

Locations

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

Interoperability endpoints

  • Direct secure messaging: sushma.kapur@direct.stonybrookmedicine.edu

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.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447027200000",
    "number": "1609817949",
    "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": "631-444-0650",
            "fax_number": "631-638-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NICOLLS RD # LEVEL4",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903407",
            "telephone_number": "631-638-4170",
            "fax_number": "631-638-4179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAPUR",
        "first_name": "SUSHMA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2015-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.