NPIMap

Organization Active NPI

Timothy D. Groth MD PC

  • Multi-Specialty Clinic/Center
  • Smithtown, NY
National Provider Identifier
1720022015
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
TIMOTHY D. GROTH MD PC
Practice address
994 W Jericho Tpke
Suite104
Smithtown, NY 11787-3235
Phone
(631) 543-1440
Fax
(631) 543-1930
NPI assigned
Jun 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Authorized official

Name
Timothy D Groth, M.D.NPI 1093742272
Title
Physician
Phone
(631) 543-1440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

994 W Jericho Tpke
Suite104
Smithtown, NY 11787-3235

Mailing address

994 W Jericho Tpke
Suite104
Smithtown, NY 11787-3235
Phone (631) 543-1440

Other identifiers 1

IdentifierTypeStateIssuer
01491318MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060825000424 NY Part B Supplier - Clinic/Group Practice 8921002320 Receives reassigned benefits from 61 practitioners
Practice locations: Centereach, NY; East Patchogue, NY; Farmingdale, NY; Hicksville, NY; Lindenhurst, NY; Merrick, NY; Mineola, NY; North Massapequa, NY…
O20200623002219 NY DME Supplier - Physician - Interventional Pain Management 8921002320 Practice locations: Smithtown, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2020630Timothy D Groth MD PC994 West Jericho Turnpike Ste 104, Smithtown, NY 11787Certificate of waiverFeb 23, 2027

National Provider Directory

National Provider Directory

Locations

1500 Middle Country Rd
Ste 3
Centereach, NY 11720

913 N Broadway
North Massapequa, NY 11758
Phone (516) 454-6387

887 Old Country Rd
Ste F
Riverhead, NY 11901

100 N Village Ave
Ste 30
Rockville Centre, NY 11570

100 N Centre Ave
Ste 302
Rockville Centre, NY 11570

100 N Centre Ave
Ste 30
Rockville Centre, NY 11570

1500 William Floyd Pkwy
Ste 201
Shirley, NY 11967
Phone (631) 205-0800

994 W Jericho Tpke
Ste 104
Smithtown, NY 11787
Phone (516) 400-3595

32 Station Dr
Wyandanch, NY 11798
Phone (516) 798-8363

Practitioners & affiliated clinicians

Practitioners 66

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604880000000",
    "number": "1720022015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "994 W JERICHO TPKE",
            "address_2": "SUITE104",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873235",
            "telephone_number": "631-543-1440",
            "fax_number": "631-543-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "994 W JERICHO TPKE",
            "address_2": "SUITE104",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117873235",
            "telephone_number": "631-543-1440",
            "fax_number": "631-543-1930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY D. GROTH MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A",
        "authorized_official_last_name": "GROTH",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "631-543-1440",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01491318",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; 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.