Active NPI
Peter Smith, D.P.M.
- Podiatrist
- Stony Brook, NY
National Provider Identifier
1851361414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- N004433
- Practice address
- 207 Hallock Rd
Suite 4
Stony Brook, NY 11790-3033 - Phone
- (631) 689-2300
- Fax
- (631) 689-2078
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | N004433 | NY | Primary |
| Sports Medicine Podiatrist | 213ES0000X | PD1905 | MA |
Addresses
Primary practice location
207 Hallock Rd
Suite 4
Stony Brook, NY 11790-3033
Mailing address
207 Hallock Rd
Suite 4
Stony Brook, NY 11790-3033
Phone (631) 689-2300
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P1911509 | Other | NY | OXFORD |
| 01895183 | Medicaid | NY | |
| PO 44330 | Other | NY | WORKERS COMPENSATION |
| NYB002451 | Other | NY | SUBMITTER ID |
| 6364966004 | Other | NY | CIGNA |
| 10259 | Other | NY | VYTRA |
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100803000017 | NY | Practitioner - Podiatry | 6406989144 | Practice locations: Stony Brook, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Podiatry
- Education
- New York College of Podiatric Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
207 Hallock Rd
Suite 4
Stony Brook, NY 11790-3033
207 Hallock Rd
Suite 4
Stony Brook, NY 11790-3072
Phone (631) 689-2300
Merit-based Incentive Payment System (MIPS)
- Final score
- 0 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 0
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 56 |
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 982 |
| Removal or shaving of skin growth | 561 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N004433 | NY | MD | Podiatrist |
| PD1905 | MA | MD | Sports Medicine Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cherrywood Foot Care Group PC | Podiatrist | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.meditouchehr.com/api/fhir/r4/
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 and National Provider Directory roles.
-
- Podiatrist
- North Bellmore, NY
- NPI 1891899381
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202774400000",
"number": "1851361414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 HALLOCK RD",
"address_2": "SUITE 4",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117903033",
"telephone_number": "631-689-2300",
"fax_number": "631-689-2078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 HALLOCK RD",
"address_2": "SUITE 4",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117903033",
"telephone_number": "631-689-2300",
"fax_number": "631-689-2078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "PETER",
"name_prefix": "Dr.",
"credential": "D.P.M.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-25",
"last_updated": "2008-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NY",
"license": "N004433",
"primary": true
},
{
"code": "213ES0000X",
"taxonomy_group": "",
"desc": "Podiatrist, Sports Medicine",
"state": "MA",
"license": "PD1905",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P1911509",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01895183",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKERS COMPENSATION",
"identifier": "PO 44330",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUBMITTER ID",
"identifier": "NYB002451",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "6364966004",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VYTRA",
"identifier": "10259",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.