Individual provider Active NPI

Anang Modi, DO

  • Internal Medicine Physician
  • Lake Ronkonkoma, NY
National Provider Identifier
1790724557
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
231966 Issued in NY
Practice address
640 Hawkins Ave
Lake Ronkonkoma, NY 11779-2324
Phone
(631) 737-0100
Fax
(631) 417-1117
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 231966 NY Primary

Addresses

Primary practice location

640 Hawkins Ave
Lake Ronkonkoma, NY 11779-2324

Mailing address

55 Water St
12TH Floor - Credentialing
New York, NY 10041-0004
Phone (646) 680-2888

Other identifiers 1

IdentifierTypeStateIssuer
02800686MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amodi204153@nyumc.direct-ci.com

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070509000762 NY Practitioner - Rheumatology 5092811976 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
New York College of Osteo Medicine of New York Institute of Technology, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
FL 2
New York, NY 10006-1995
Phone (212) 263-9701

13303 Jamaica Ave
Jamaica, NY 11418-2618
Phone (718) 206-6923

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
New York University Internal Medicine CurrentSince Jun 1, 2017 Accepting new patients
New York University Internal Medicine CurrentSince Jun 1, 2017 Accepting new patients
Marie Laura Leon M.D P.C Past Accepting new patients

Locations

789 Park Ave
Huntington, NY 11743
Phone (631) 386-3402

1999 Marcus Ave
North New Hyde Park, NY 11042
Phone (516) 233-3701

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

111 Broadway
Fl 2
Trinity, NY 10006
Phone (212) 263-9700

70 E Sunrise Hwy
Valley Stream, NY 11581
Phone (516) 825-3600

Networks

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

Interoperability endpoints

  • Direct secure messaging: amodi204153@nyumc.direct-ci.com

Organizations & group practices 3

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 8

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": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1790724557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WATER ST",
            "address_2": "12TH FLOOR - CREDENTIALING",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100410004",
            "telephone_number": "646-680-2888",
            "fax_number": "516-542-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 HAWKINS AVE",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792324",
            "telephone_number": "631-737-0100",
            "fax_number": "631-417-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODI",
        "first_name": "ANANG",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "231966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02800686",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amodi204153@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "1999 Marcus Ave",
            "city": "New Hyde Park",
            "state": "NY",
            "country_code": "US",
            "postal_code": "110421033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake Ronkonkoma, NY

Sources for this page

Verify at the official NPI Registry.