NPIMap

Individual provider Active NPI

Gustavo Sanroman, M.D.

  • Obstetrics & Gynecology Physician
  • Port Jefferson Station, NY
National Provider Identifier
1619917960
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
173068 Issued in NY
Practice address
5225 Route 347
Suite 70
Port Jefferson Station, NY 11776-2053
Phone
(800) 645-3203
Fax
(631) 474-9169
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 173068 NY Primary

Addresses

Primary practice location

5225 Route 347
Suite 70
Port Jefferson Station, NY 11776-2053

Mailing address

45 Research Way Ste 105
East Setauket, NY 11733-6401
Phone (631) 675-2125

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Gustavo.SanRoman@sbcm.cernerdirect.com

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
I20041208000820 NY Practitioner - Obstetrics/Gynecology 4688630999 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Pennsylvania State University College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-8091
Phone (631) 444-7650

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-4686

Lauterbur Dr
Stony Brook, NY 11794-0001
Phone (631) 638-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
173068NYMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Associates in Obstetrics & Gynecology, University Faculty P Obstetrics & Gynecology CurrentSince Nov 1, 2018 Accepting new patients
St Charles Hospital Corp Past Accepting new patients
Stony Brook Gynecology & Obstetrics, P.C. Obstetrics & Gynecology Past Accepting new patients

Locations

191 Herricks Rd
New Hyde Park, NY 11040
Phone (516) 248-0144

5225 Route 347
Ste 70
Port Jefferson Station, NY 11776
Phone (631) 331-8777

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Networks

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

Interoperability endpoints

  • Direct secure messaging: gustavosanroman@ap-ny.direct.office.nextgen.com

Organizations & group practices 3

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 7

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1619917960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 RESEARCH WAY STE 105",
            "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": "5225 ROUTE 347",
            "address_2": "SUITE 70",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762053",
            "telephone_number": "800-645-3203",
            "fax_number": "631-474-9169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANROMAN",
        "first_name": "GUSTAVO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "173068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Gustavo.SanRoman@sbcm.cernerdirect.com",
            "affiliation": "N",
            "address_1": "5225 Route 347",
            "address_2": "Suite 70",
            "city": "Port Jefferson Station",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117762053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.