NPIMap

Organization Active NPI

Central Suffolk Hosptial

Doing business as Peconic Bay Medical Center

  • Nurse Practitioner
  • Riverhead, NY
National Provider Identifier
1841637741
Registry record updated Aug 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
CENTRAL SUFFOLK HOSPTIAL
Doing business as
Peconic Bay Medical Center
Practice address
1300 Roanoke Ave
Riverhead, NY 11901-2031
Phone
(631) 548-6101
Fax
(631) 548-6007
NPI assigned
May 31, 2013
Last updated
Aug 31, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2016

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

Authorized official

Name
Michael O'Donnell
Title
Senior VP Finance/Cfo
Phone
(631) 548-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

1300 Roanoke Ave
Riverhead, NY 11901-2031

Mailing address

1300 Roanoke Ave
Riverhead, NY 11901-2031
Phone (631) 548-6101

Other names 1

  • PECONIC BAY MEDICAL CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031120000840 NY Part B Supplier - Clinic/Group Practice 4981508082 Receives reassigned benefits from 188 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riverhead, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

755 New York Ave
Ste 100
Huntington, NY 11743
Phone (631) 548-6432

244 Old Country Rd
Ste 2
Riverhead, NY 11901
Phone (631) 548-6432

Practitioners & affiliated clinicians

Practitioners 141

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 141

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1841637741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012031",
            "telephone_number": "631-548-6101",
            "fax_number": "631-548-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012031",
            "telephone_number": "631-548-6101",
            "fax_number": "631-548-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL SUFFOLK HOSPTIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "O'DONNELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "SENIOR VP FINANCE/CFO",
        "authorized_official_telephone_number": "631-548-6000"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PECONIC BAY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.