NPIMap

Individual provider Active NPI

Michael Petelis, DO

  • Family Medicine Physician
  • Mineola, NY
National Provider Identifier
1699861237
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
211294 Issued in NY
Practice address
300 Old Country Rd
Suite 211
Mineola, NY 11501-4198
Phone
(516) 280-2599
Fax
(516) 280-2597
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 211294 NY Primary

Addresses

Primary practice location

300 Old Country Rd
Suite 211
Mineola, NY 11501-4198

Mailing address

300 Old Country Rd
Suite 211
Mineola, NY 11501-4198
Phone (516) 280-2599

Other identifiers 1

IdentifierTypeStateIssuer
211294OtherNYLICENSE

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
I20090312000313 NY Practitioner - Internal Medicine 8325104524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Li-Queens Medical Associates, PCGroup PAC ID 8628134921, 4 clinicians

Practice addresses (Care Compare)

300 Old Country Rd
Suite 211
Mineola, NY 11501-4112
Phone (516) 280-2599

Hospital & facility affiliations

  • NYU Langone Home Health Care Home health agency, Garden City, NY, CCN 337187
  • VNS of Ny Home Care Chha Home health agency, New York, NY, CCN 337008
  • Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
  • Emerest Home Health Care of Long Island Home health agency, Flushing, NY, CCN 337189
  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106
  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
211294NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Shore Family Medical Associates, P.C. Family Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mpetelismd@liqueensmedical.ssdirect.aprima.com

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 and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260230400000",
    "number": "1699861237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 OLD COUNTRY RD",
            "address_2": "SUITE 211",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014198",
            "telephone_number": "516-280-2599",
            "fax_number": "516-280-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OLD COUNTRY RD",
            "address_2": "SUITE 211",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014198",
            "telephone_number": "516-280-2599",
            "fax_number": "516-280-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETELIS",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "211294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "211294",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.