Michael James Petersen, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

175936 Issued in NY

Practice address

4 Technology Dr
Suite 120
East Setauket, NY 11733-4068

Phone

(631) 246-8289

Fax

(631) 246-8294

NPI assigned

Aug 24, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 9

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Vascular Surgery

Education

Baylor College of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Harbor View Medical Services PCGroup PAC ID 5092865873, shared by 3 NPIs, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peconic Bay Homehealth Services Home health agency, Riverhead, NY, CCN 337400
• John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
• Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: michael.petersen.1@8551.direct.athenahealth.com

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.

• Harbor View Medical Services PC

  dba Mather Medical Group

  • Internal Medicine Physician
  • Port Jefferson, NY
  • NPI 1306631742
  Medicare reassignment NPD
• Harbor View Medical Services PC

  • Pulmonary Disease Physician
  • Port Jefferson, NY
  • NPI 1861636219
  Medicare reassignment NPD
• Harbor View Medical Services PC

  • Vascular Surgery Physician
  • East Setauket, NY
  • NPI 1255741153
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Central Suffolk Hospital

  dba Peconic Bay Homehealth Services

  • Home Health Agency
  • Riverhead, NY
  • NPI 1932155678
  Care Compare affiliation
• John T. Mather Memorial Hospital

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1093718728
  Care Compare affiliation
• University Hospital at Stony Brook

  dba Stony Brook Southampton Hospital

  • General Acute Care Hospital
  • Southampton, NY
  • NPI 1033224704
  Care Compare affiliation
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Southampton, NY
  • NPI 1225507114
  Care Compare affiliation
• University Hospital at Stony Brook

  • Land Ambulance
  • Stony Brook, NY
  • NPI 1306620588

  Hospital

  Care Compare affiliation
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Greenport, NY
  • NPI 1881690691
  Care Compare affiliation
• University Hospital at Stony Brook

  • Clinic/Center
  • Greenport, NY
  • NPI 1932466604

  Hospital

  Care Compare affiliation
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Stony Brook, NY
  • NPI 1972523348
  Care Compare affiliation

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465171200000",
    "number": "1902899057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 TECHNOLOGY DR",
            "address_2": "SUITE 120",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117334068",
            "telephone_number": "631-246-8289",
            "fax_number": "631-246-8294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 TECHNOLOGY DR",
            "address_2": "SUITE 120",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117334068",
            "telephone_number": "631-246-8289",
            "fax_number": "631-246-8294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2016-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "175936",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NY",
            "license": "175936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "2C4298",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE",
            "identifier": "0714028004",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "990015026",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUFFOLK HEALTH PLANS",
            "identifier": "S500051",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1199 BENEFIT FUND",
            "identifier": "11347567803",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTH PLANS",
            "identifier": "2110430",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "CS1072",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1261940",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0103702",
            "identifier": "GHI PPO CBP",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candice Perkins, M.D.
• Seth Evan Persky, MD
• Melissa Peskin-Stolze, M.D.
• David L Peters, D.O.
• Matthew Petersen, P.A.
• Douglas Matthew Petraco, MD
• Rebecca Anne Petrie, LCSW
• Thomas Joseph Pettei, M.D.
• Jedan Phillips, M.D.
• Antonia Michelle Pinto, NP

• Vascular Surgery Physician in East Setauket, NY
• Providers in East Setauket, NY by specialty
• Vascular Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; 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.

Verify at the official NPI Registry.