NPIMap

Individual provider Active NPI

Douglas Matthew Petraco, MD

  • Orthopaedic Surgery Physician
  • East Setauket, NY
National Provider Identifier
1922021476
Registry record updated Mar 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
195619 Issued in NY
Practice address
6 Technology Dr Ste 100
East Setauket, NY 11733-4079
Phone
(631) 689-6698
Fax
(631) 751-5548
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 195619 NY
Orthopaedic Surgery Physician 207X00000X 195619 NY Primary

Addresses

Primary practice location

6 Technology Dr Ste 100
East Setauket, NY 11733-4079

Mailing address

6 Technology Dr Ste 100
East Setauket, NY 11733-4079
Phone (631) 689-6698

Other identifiers 1

IdentifierTypeStateIssuer
02011645MedicaidNY

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
I20100813000411 NY Practitioner - Orthopedic Surgery 5496889362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
JS Weill Medical College, Cornell University, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cora Health Services IncGroup PAC ID 1759290992, shared by 21 NPIs, 1,125 clinicians

Practice addresses (Care Compare)

1050 Old Camp Rd
Suite 282
The Villages, FL 32162-1762
Phone (352) 693-3378

6144 Route 25a
Suite 5
Wading River, NY 11792-2008
Phone (631) 689-6698

Hospital & facility affiliations

  • Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
  • St Catherine of Siena Hospital Hospital, Smithtown, NY, CCN 330401
  • 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
19.06 of 100Reported as individual
Quality
4.22
Promoting interoperability
0
Improvement activities
0
Cost
59.3

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement81
Knee replacement139
Lower limb (leg) arthroscopy (minimally invasive joint repair)26

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
195619NYMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Assoc of Long Island Physicians & Medical Group PLLC CurrentSince Jun 20, 2019 Accepting new patients
Orthopedic Associates of Long Island LLP Orthopaedic Surgery CurrentSince Aug 1, 1998 Accepting new patients
Orthopedic Assoc of Long Island Physicians & Medical Group PLLC Orthopaedic Surgery CurrentSince Jun 20, 2019 Accepting new patients
Precision SC, LLC Past Accepting new patients

Locations

2112 Middle Country Rd
Centereach, NY 11720
Phone (631) 247-7463

6 Technology Dr
Ste 100
East Setauket, NY 11733
Phone (631) 371-2685

28 Research Way
East Setauket, NY 11733
Phone (631) 380-2710

715 Roanoke Ave
Ste 3
Riverhead, NY 11901
Phone (631) 963-4770

6144 Route 25A
Ste 5
Wading River, NY 11792

Networks

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

Interoperability endpoints

  • Direct secure messaging: douglaspetraco@oali.ssdirect.aprima.com

Organizations & group practices 4

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 10

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552867200000",
    "number": "1922021476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 TECHNOLOGY DR STE 100",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117334079",
            "telephone_number": "631-689-6698",
            "fax_number": "631-751-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 TECHNOLOGY DR STE 100",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117334079",
            "telephone_number": "631-689-6698",
            "fax_number": "631-751-5548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRACO",
        "first_name": "DOUGLAS",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2019-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "NY",
            "license": "195619",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "195619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02011645",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

Verify at the official NPI Registry.