NPIMap

Organization Active NPI

University Hospital at Stony Brook

  • General Acute Care Hospital
  • Greenport, NY
National Provider Identifier
1881690691
Registry record updated Jul 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
UNIVERSITY HOSPITAL AT STONY BROOK
Practice address
201 Manor PL
Greenport, NY 11944-1222
Phone
(631) 477-1000
Fax
(631) 477-1746
NPI assigned
Jun 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2019

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

Authorized official

Name
Paul Connor
Title
Cao
Phone
(631) 477-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

201 Manor PL
Greenport, NY 11944-1222

Mailing address

201 Manor PL
Greenport, NY 11944-1222
Phone (631) 477-1000

Other identifiers 2

IdentifierTypeStateIssuer
00274337MedicaidNY
000538OtherBLUE CROSS

Other names 1

  • Stony Brook Eastern Long Island Hospital Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000092 NY Part A Provider - Hospital 2365341856 7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lake Grove, NY; Riverhead, NY; Ronkonkoma, NY; Smithtown, NY; Southampton, NY; Southold, NY; Stony Brook, NY; Westhampton Beach, NY…

Hospital certification: CCN 330393

Legal name
UNIVERSITY HOSPITAL AT STONY BROOK
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jan 1, 1980
Last certification
Oct 4, 2024
Beds
728
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
100 Nicolls Rd
Stony Brook, NY 11794-8410
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Suny/Stony Brook University HospitalCCN 330393
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Stony Brook University Medical Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

33 Research Way
Ste 9
East Setauket, NY 11733
Phone (631) 444-4240

147 Beach Rd
Westhampton Beach, NY 11978
Phone (631) 288-7746

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
University Hospital at Stony Brook Organization, Stony Brook, NY 5% Or Greater Direct Ownership Interest Jan 10, 1980 100%
Other Jan 1, 2019 100%
Carol Gomes Individual Corporate DirectorChief Executive Officer Jun 15, 2019 100%
W-2 Managing EmployeeChief Executive Officer Jun 15, 2019 100%
Gary E Bie Individual Corporate OfficerCfo Feb 10, 2011
Operational/Managerial ControlCfo Jan 1, 2019 100%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 38

Affiliated clinicians 1,851

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,851

NPI Registry JSON

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563235200000",
    "number": "1881690691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 MANOR PL",
            "city": "GREENPORT",
            "state": "NY",
            "postal_code": "119441222",
            "telephone_number": "631-477-1000",
            "fax_number": "631-477-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MANOR PL",
            "city": "GREENPORT",
            "state": "NY",
            "postal_code": "119441222",
            "telephone_number": "631-477-1000",
            "fax_number": "631-477-1746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY HOSPITAL AT STONY BROOK",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2019-07-16",
        "status": "A",
        "authorized_official_last_name": "CONNOR",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "631-477-1000"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00274337",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000538",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stony Brook Eastern Long Island Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenport, NY

Sources for this page

Verify at the official NPI Registry.