NPIMap

Individual provider Active NPI

Jay P Slotkin, MD

  • Internal Medicine Physician
  • Southold, NY
National Provider Identifier
1780650226
Registry record updated Oct 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
145688 Issued in NY
Practice address
50 Ackerly Pond LN
Southold, NY 11971-3005
Phone
(631) 765-1414
Fax
(631) 765-1428
NPI assigned
Feb 24, 2006
Last updated
Oct 29, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 1456881 NY
Internal Medicine Physician 207R00000X 145688 NY Primary

Addresses

Primary practice location

50 Ackerly Pond LN
Southold, NY 11971-3005

Mailing address

PO Box 1437
Southold, NY 11971-0938
Phone (631) 765-1414

Other identifiers 5

IdentifierTypeStateIssuer
267AM1OtherNYEMPIRE BLUE SHIELD
P3555349OtherNYOXFORD
10210OtherNYVYTRA
9199852OtherNYGHI
00658966MedicaidNY

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
I20040514000967 NY Practitioner - Internal MedicinePractitioner - Geriatric Medicine 2365432093 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
State University of Ny Upstate Medical University, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

50 Akerly Pond LN
Southold, NY 11971-3005
Phone (631) 765-1414

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1456881NYMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East End Geriatric & Adult Medicine PLLC Geriatric Medicine CurrentSince Jan 1, 2004 Accepting new patients
San Simeon by the Sound Center for Nursing and Rehabilitation, Inc. Past Accepting new patients

Locations

50 Akerly Pond Ln
Southold, NY 11971
Phone (631) 765-1414

Networks

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IHICDD/Endpoint/IHICDD
  • Direct secure messaging: jslotkin@yourcarecommunity.org

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": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256774400000",
    "number": "1780650226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1437",
            "city": "SOUTHOLD",
            "state": "NY",
            "postal_code": "119710938",
            "telephone_number": "631-765-1414",
            "fax_number": "631-765-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 ACKERLY POND LN",
            "city": "SOUTHOLD",
            "state": "NY",
            "postal_code": "119713005",
            "telephone_number": "631-765-1414",
            "fax_number": "631-765-1428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLOTKIN",
        "first_name": "JAY",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2009-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "1456881",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "145688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUE SHIELD",
            "identifier": "267AM1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3555349",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA",
            "identifier": "10210",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "9199852",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00658966",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southold, NY

Sources for this page

Verify at the official NPI Registry.