NPIMap

Individual provider Active NPI

Philippe Vaillancourt, MD

  • Neurology Physician
  • Islip, NY
National Provider Identifier
1801861976
Registry record updated Jun 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
139436 Issued in NY
Practice address
712 Main St
Islip, NY 11751-3620
Phone
(631) 666-3939
Fax
(631) 666-3994
NPI assigned
Feb 21, 2006
Last updated
Jun 9, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 139436 NY Primary
Pain Medicine Physician 208VP0000X 139436 NY

Addresses

Primary practice location

712 Main St
Islip, NY 11751-3620

Mailing address

712 Main St
Islip, NY 11751-3620
Phone (631) 666-3939

Other identifiers 1

IdentifierTypeStateIssuer
00976572MedicaidNY

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
I20041119001035 NY Practitioner - NeurologyPractitioner - Pain Management 5698730554 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Pain Management
Education
Other, 1978
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)

1279 E Main St
Riverhead, NY 11901-2583
Phone (631) 727-2100

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 Medicine

State licenses

LicenseStateTypeSpecialty
139436NYMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince May 1, 2023 Accepting new patients
New York University CurrentSince May 1, 2023 Accepting new patients
Max Rudansky, MD & Jacques Winter MD, PC Neurology Past Accepting new patients

Locations

77 Route 112
Patchogue, NY 11772
Phone (631) 207-2370

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

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

1279 E Main St
Riverhead, NY 11901
Phone (631) 727-2100

877 E Main St
Ste 106
Riverhead, NY 11901
Phone (631) 727-0660

Networks

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

Interoperability endpoints

  • Direct secure messaging: pvaillancourt535672@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465430400000",
    "number": "1801861976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513620",
            "telephone_number": "631-666-3939",
            "fax_number": "631-666-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 MAIN ST",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117513620",
            "telephone_number": "631-666-3939",
            "fax_number": "631-666-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAILLANCOURT",
        "first_name": "PHILIPPE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2016-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "139436",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NY",
            "license": "139436",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00976572",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Islip, NY

Sources for this page

Verify at the official NPI Registry.