Individual provider Active NPI

Valmore Joseph Suprenant, M.D.

  • Vascular & Interventional Radiology Physician
  • Stony Brook, NY
National Provider Identifier
1841513645
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
256500 Issued in NY
Practice address
100 Nicolls Road
HSC Level 4; Room 120
Stony Brook, NY 11794-8460
Phone
(631) 444-5400
Fax
(631) 444-7538
NPI assigned
Mar 8, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MT186105 PA
Vascular & Interventional Radiology Physician 2085R0204X 256500 NY Primary

Addresses

Primary practice location

100 Nicolls Road
HSC Level 4; Room 120
Stony Brook, NY 11794-8460

Mailing address

HSC Level 4, Room 120
Stony Brook, NY 11794-8460
Phone (631) 444-5400

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address valmore.suprenant@direct.stonybrookmedicine.edu

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
I20110613000863 NY Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 3779760095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
Temple University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-3407
Phone (631) 638-2121

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT186105PAMDDiagnostic Radiology Physician
256500NYMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Radiology, University Faculty Practice Corporation Diagnostic Radiology CurrentSince Jul 1, 2011 Accepting new patients

Locations

100 Nicolls Rd
Rm 120
Stony Brook, NY 11794
Phone (631) 444-2480

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Hsc Level 4
Rm 120
Stony Brook, NY 11794
Phone (631) 444-7955

Organizations & group practices 1

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 6

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": "1268006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1841513645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HSC LEVEL 4, ROOM 120",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948460",
            "telephone_number": "631-444-5400",
            "fax_number": "631-444-7538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NICOLLS ROAD",
            "address_2": "HSC LEVEL 4; ROOM 120",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948460",
            "telephone_number": "631-444-5400",
            "fax_number": "631-444-7538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPRENANT",
        "first_name": "VALMORE",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-08",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MT186105",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NY",
            "license": "256500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "valmore.suprenant@direct.stonybrookmedicine.edu",
            "affiliation": "N",
            "address_1": "100 Nicolls Road",
            "address_2": "HSC Level 4; Room 120",
            "city": "Stony Brook",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117948460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.