Individual provider Active NPI

Vincent Paul Detrinis, D.C.

  • Chiropractor
  • Port Jefferson Station, NY
National Provider Identifier
1710102165
Registry record updated Feb 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X4504 Issued in NY
Practice address
3 Sage Rd
Port Jefferson Station, NY 11776-1817
Phone
(631) 689-2993
NPI assigned
Apr 13, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X4504 NY Primary

Addresses

Primary practice location

3 Sage Rd
Port Jefferson Station, NY 11776-1817

Mailing address

3 Sage Rd
Port Jefferson Station, NY 11776-1817
Phone (631) 689-2993

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041129000327 NY Practitioner - Chiropractic 8022073386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3 Sage Rd
Port Jefferson Station, NY 11776-1817
Phone (631) 689-2993

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X4504NYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Vincent P. Detrinis, D.C., P.C. Chiropractor CurrentSince Apr 1, 2005 Accepting new patients

Locations

100 N Country Rd
Setauket, NY 11733
Phone (631) 689-2993

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266537600000",
    "number": "1710102165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 SAGE RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761817",
            "telephone_number": "631-689-2993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SAGE RD",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761817",
            "telephone_number": "631-689-2993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETRINIS",
        "first_name": "VINCENT",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2010-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X4504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.