NPIMap

Individual provider Active NPI

Eilliut Alicea, MD

  • Student in an Organized Health Care Education/Training Program
  • Brooklyn, NY
National Provider Identifier
1639667165
Registry record updated Apr 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
450 Clarkson Ave
Dept. of Internal Medicine
Brooklyn, NY 11203-2012
Phone
(718) 270-2030
NPI assigned
Apr 30, 2018
Last updated
Apr 30, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU Primary

Addresses

Primary practice location

450 Clarkson Ave
Dept. of Internal Medicine
Brooklyn, NY 11203-2012

Mailing address

450 Clarkson Ave
Brooklyn, NY 11203-2012

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
I20211229001212 NY Practitioner - Internal Medicine 3274924212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Suffolk Medical PCGroup PAC ID 0244396349, 204 clinicians

Practice addresses (Care Compare)

100 Port Washington Blvd
Roslyn, NY 11576-1347
Phone (516) 562-6385

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.24 of 100Reported as individual
Quality
98.74
Improvement activities
0
Cost
83.11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Suffolk Medical, P.C. CurrentSince Jan 4, 2022 Accepting new patients
Southwest Suffolk Medical PC CurrentSince Jan 4, 2022 Accepting new patients

Locations

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

Networks

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

Organizations & group practices 2

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": "1525046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525046400000",
    "number": "1639667165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "address_2": "DEPT. OF INTERNAL MEDICINE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012",
            "telephone_number": "718-270-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALICEA",
        "first_name": "EILLIUT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-30",
        "last_updated": "2018-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.