Active NPI
Jedan Phillips, M.D.
- Family Medicine Physician
- East Setauket, NY
National Provider Identifier
1659317956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 226998
- Practice address
- 181 N Belle Mead Rd
East Setauket, NY 11733-3495 - Phone
- (111) 111-1111
- NPI assigned
- Jun 22, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 226998 | NY | Primary |
Addresses
Primary practice location
181 N Belle Mead Rd
East Setauket, NY 11733-3495
Mailing address
PO Box 1559
Stony Brook, NY 11790-0989
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02361939 | Medicaid | NY | |
| 7044409 | Other | NY | AETNA |
| 54V391 | Other | NY | EMPIRE BC.BS |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Maryland School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5858
101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5858
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stony Brook Family and Preventive Medicine, University Faculty Practic | Family Medicine | Current | Accepting new patients |
Locations
285 Sills Rd
Bldg D
East Patchogue, NY 11772
181 N Belle Mead Rd
Setauket, NY 11733
Phone (631) 444-0624
100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Interoperability endpoints
- jedan.phillips@direct.stonybrookmedicine.edu
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Stony Brook, NY
- NPI 1982659470
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Catholic Health Home Care
- Home Health Agency
- Farmingdale, NY
- NPI 1780670711
-
dba Tender Loving Care, an Amedisys Company
- Home Health Agency
- Medford, NY
- NPI 1699715961
-
dba Stony Brook Southampton Hospital
- General Acute Care Hospital
- Southampton, NY
- NPI 1033224704
-
- General Acute Care Hospital
- Southampton, NY
- NPI 1225507114
-
- General Acute Care Hospital
- Greenport, NY
- NPI 1881690691
-
- General Acute Care Hospital
- Stony Brook, NY
- NPI 1972523348
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659317956",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "181 N BELLE MEAD RD",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "117333495",
"telephone_number": "111-111-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "JEDAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "226998",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02361939",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7044409",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BC.BS",
"identifier": "54V391",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Setauket, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.