NPIMap

Individual provider Active NPI

Ajay V. Berdia, M.D.

  • Specialist
  • Port Jefferson, NY
National Provider Identifier
1801891908
Registry record updated Jun 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
196859 Issued in NY
Practice address
640 Belle Terre Road, Building H
Port Jefferson, NY 11777-0001
Phone
(631) 474-1112
Fax
(631) 474-1112
NPI assigned
Jun 15, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 196859 NY Primary

Addresses

Primary practice location

640 Belle Terre Road, Building H
Port Jefferson, NY 11777-0001

Mailing address

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 474-6300

Other identifiers 9

IdentifierTypeStateIssuer
130019918OtherNYRAIL ROAD MEDICARE
2190491OtherNYAETNA HEALTH PLANS
810620OtherNYFIRST HEALTH INSURANCE
P560221OtherNYOXFORD HEALTH PLANS
3099464OtherNYGHI HEALTH INSURANCE
087312OtherNYBLUE CROSS BLUE SHIELD
48613OtherNYVYTRA HEALTH PLANS
01524845MedicaidNY
196859OtherNYHIP HEALTH PLANS

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
I20050519000625 NY Practitioner - Neurology 9133022619 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Charles Hospital CorpGroup PAC ID 6103733050, 62 clinicians

Practice addresses (Care Compare)

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 474-6000

Hospital & facility affiliations

  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
  • Good Samaritan Hospital Medical Center Hospital, West Islip, NY, CCN 330286

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
196859NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
St Charles Hospital Corp CurrentSince Oct 4, 2013 Accepting new patients
Family Residences and Essential Enterprises, Inc. Past Accepting new patients
Skills Unlimited, Inc. Past Accepting new patients

Locations

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

Networks

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

Organizations & group practices 4

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 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": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402012800000",
    "number": "1801891908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771928",
            "telephone_number": "631-474-6300",
            "fax_number": "631-474-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 BELLE TERRE ROAD, BUILDING H",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117770001",
            "telephone_number": "631-474-1112",
            "fax_number": "631-474-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERDIA",
        "first_name": "AJAY",
        "middle_name": "V.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2014-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "196859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "130019918",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTH PLANS",
            "identifier": "2190491",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH INSURANCE",
            "identifier": "810620",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "P560221",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI HEALTH INSURANCE",
            "identifier": "3099464",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "087312",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA HEALTH PLANS",
            "identifier": "48613",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01524845",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP HEALTH PLANS",
            "identifier": "196859",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.