NPIMap

Individual provider Active NPI

Kevin L Tack, M.D.

  • Gastroenterology Physician
  • Manhasset, NY
National Provider Identifier
1871599605
Registry record updated Dec 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
180244 Issued in NY
Practice address
1615 Northern Blvd
Manhasset, NY 11030-3033
Phone
(516) 627-3717
Fax
(516) 869-8625
NPI assigned
Jun 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 180244 NY Primary

Addresses

Primary practice location

1615 Northern Blvd
Manhasset, NY 11030-3033

Mailing address

1615 Northern Blvd
Manhasset, NY 11030-3033
Phone (516) 627-3717

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
I20050404000337 NY Practitioner - Gastroenterology 0547217465 Reassigns benefits to 2 organizations
Practice locations: Great Neck, NY

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
State University of New York at Buffalo School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1155 Northern Blvd
Manhasset, NY 11030-3040
Phone (516) 390-2850

Hospital & facility affiliations

  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106
  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy292
Upper gastrointestinal (GI) endoscopy for acid reflux103

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Medical Group of the Mount Sinai School of Medicine CurrentSince Sep 1, 2018 Accepting new patients
Mount Sinai School of Medicine CurrentSince Jan 1, 2014 Accepting new patients
North Shore Medical Group of the Mount Sinai School of Medicine Gastroenterology CurrentSince Sep 1, 2018 Accepting new patients
Mount Sinai School of Medicine Past Accepting new patients
North Shore-Lij Medical PC Past Accepting new patients

Locations

325 Park Ave
Huntington, NY 11743
Phone (631) 351-3700

1155 Northern Blvd
Manhasset, NY 11030
Phone (516) 407-4000

Networks

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

Interoperability endpoints

  • Direct secure messaging: ktack22288@direct-chsli.net

Organizations & group practices 5

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 8

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": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259884800000",
    "number": "1871599605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 NORTHERN BLVD",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303033",
            "telephone_number": "516-627-3717",
            "fax_number": "516-869-8625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 NORTHERN BLVD",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303033",
            "telephone_number": "516-627-3717",
            "fax_number": "516-869-8625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACK",
        "first_name": "KEVIN",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2009-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "180244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhasset, NY

Sources for this page

Verify at the official NPI Registry.