Individual provider Active NPI

Kevin Filetto, PA

  • Physician Assistant
  • Port Jefferson, NY
National Provider Identifier
1902581879
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
635 Belle Terre Rd Ste 204
Port Jefferson, NY 11777-1977
Phone
(631) 302-7349
NPI assigned
Jun 19, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

635 Belle Terre Rd Ste 204
Port Jefferson, NY 11777-1977

Mailing address

12 Old Neck CT
Manorville, NY 11949-3232
Phone (631) 506-1332

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231025003310 NY Practitioner - Physician Assistant 1456707546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
True North Medical Group PCGroup PAC ID 7012194806, 185 clinicians

Practice addresses (Care Compare)

36 Lincoln Ave
Rockville Centre, NY 11570-5768
Phone (516) 536-2800

635 Belle Terre Rd
Suite 204
Port Jefferson, NY 11777-1977
Phone (631) 474-0224

75 N Country Rd
Port Jefferson, NY 11777-2119
Phone (631) 473-1320

788 Harrison Ave
Riverhead, NY 11901-2744
Phone (631) 591-3801

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
True North Medical Group PC CurrentSince Sep 1, 2023 Accepting new patients
True North Medical Group PC Physician Assistant CurrentSince Sep 1, 2023 Accepting new patients
True North Medical Group PC Past Accepting new patients

Locations

3480 Veterans Memorial Hwy
Bohemia, NY 11716
Phone (631) 289-0338

8002 Kew Gardens Rd
Kew Gardens, NY 11415
Phone (718) 275-2130

1728 Sunrise Hwy
Merrick, NY 11566
Phone (516) 992-4568

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

635 Belle Terre Rd
Ste 204
Prt Jefferson, NY 11777
Phone (631) 474-0008

36 Lincoln Ave
Fl 3
Rockville Ctr, NY 11570

45 Crossways Park Dr W
Woodbury, NY 11797
Phone (516) 422-8080

Organizations & group practices 3

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 7

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": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1902581879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 OLD NECK CT",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "119493232",
            "telephone_number": "631-506-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 BELLE TERRE RD STE 204",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771977",
            "telephone_number": "631-302-7349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FILETTO",
        "first_name": "KEVIN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.