NPIMap

Organization Active NPI

John T. Mather Memorial Hospital

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Port Jefferson, NY
National Provider Identifier
1639585706
Registry record updated Jul 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
Legal business name
JOHN T. MATHER MEMORIAL HOSPITAL
Practice address
75 N Country Rd
Port Jefferson, NY 11777-2119
Phone
(631) 476-2768
Fax
(631) 474-4939
NPI assigned
Jul 9, 2014
Last updated
Jul 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2014

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

Authorized official

Name
Mr. Joseph Wisnoski
Title
Sr. VP & Cmo
Phone
(631) 473-1320

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X NU
Recovery Care Clinic/Center 261QR0800X NU
Rehabilitation Hospital 283X00000X NU
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X NU Primary

Addresses

Primary practice location

75 N Country Rd
Port Jefferson, NY 11777-2119

Mailing address

75 N Country Rd
Port Jefferson, NY 11777-2119
Phone (631) 476-2768

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130103000478 NY Part B Supplier - Hospital Department(S) 1254237753 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Jefferson, NY

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405036800000",
    "number": "1639585706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-476-2768",
            "fax_number": "631-474-4939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-476-2768",
            "fax_number": "631-474-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T. MATHER MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-09",
        "last_updated": "2014-07-11",
        "status": "A",
        "authorized_official_last_name": "WISNOSKI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "SR. VP & CMO",
        "authorized_official_telephone_number": "631-473-1320",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.