NPIMap

Organization Active NPI

Central Suffolk Hospital

Doing business as Peconic Bay Homehealth Services

  • Home Health Agency
  • Riverhead, NY
National Provider Identifier
1932155678
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
5155601 Issued in NY
Legal business name
CENTRAL SUFFOLK HOSPITAL
Doing business as
Peconic Bay Homehealth Services
Peconic Bay Medical Center
Practice address
1300 Roanoke Ave
Riverhead, NY 11901-2031
Phone
(631) 548-6000
Fax
(631) 548-6397
NPI assigned
May 25, 2006
Last updated
Dec 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Authorized official

Name
Ms. Michele L Cusack
Title
Senior Vice President & Cfo
Phone
(516) 321-6058

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 5155601 NY Primary

Addresses

Primary practice location

1300 Roanoke Ave
Riverhead, NY 11901-2031

Mailing address

1300 Roanoke Ave
Riverhead, NY 11901-2031
Phone (631) 548-6000

Other practice location 1

755 New York Ave Ste 100
Huntington, NY 11743-4240
Phone (631) 548-6432

Other practice location 2

1 Heroes Way
Riverhead, NY 11901-2054
Phone (631) 548-6432

Other identifiers 3

IdentifierTypeStateIssuer
00274328MedicaidNY
03000300MedicaidNY
000250-7OtherNYBLUE CROSS

Other names 2

  • Peconic Bay Homehealth Services Doing business as
  • Peconic Bay Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120410000228 NY Part A Provider - Home Health Agency 4981508082 Practice locations: Riverhead, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932155678. Details of each certification follow.

Home health agency certification: CCN 337400

Legal name
CENTRAL SUFFOLK HOSPITAL
Doing business as
PECONIC BAY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 15, 1994
Last certification
Dec 7, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Enrollment address
244 Old Country Rd
Ste 2
Riverhead, NY 11901-2126
HHA Branch

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Peconic Bay Homehealth ServicesCCN 337400 · All quality measures
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Nov 15, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Central Suffolk Hosp-Ca4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Anne K Nolon Individual Corporate DirectorBoard Member Jan 1, 2016
Amy E Loeb Individual Corporate DirectorBoard Member Jan 1, 2016
Richard Winslow Individual Corporate DirectorBoard Member Apr 27, 2004
George W Summers Individual Corporate OfficerBoard Secretary Jan 27, 1989
Michael J Dempsey Individual Corporate DirectorBoard Member Jan 1, 2013
Kareem Massoud Individual Corporate DirectorBoard Member Jan 1, 2016
Robert F Rose Individual Corporate DirectorBoard Member Jan 1, 2019
Emilie Roy Corey Individual Corporate DirectorBoard Member Jan 1, 2017
Northwell Healthcare Inc Organization, Westbury, NY Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 15, 2016 100%
Richard Israel Individual Corporate DirectorBoard Member Jan 27, 2011
Stephen P Ouzounian Individual Corporate DirectorBoard Member Jan 1, 2013
Sharon Patterson Individual Corporate OfficerBoard Chair Jul 27, 2000
Joan Levan Individual Corporate DirectorBoard Member Jan 27, 2011
Carol Aspinall Individual Corporate DirectorBoard Member Jan 1, 2020
Stanley Zinberg Individual Corporate DirectorBoard Member Jan 1, 2013
Marc Alessi Individual Corporate DirectorBoard Member Jan 27, 2011
Richard Musto Individual Corporate DirectorBoard Member Jan 27, 1998
Lawrence Duncklee Individual Corporate DirectorB Jan 1, 2015
Andrew J Mitchell Individual Corporate OfficerPresident and Ceo May 27, 2001
W-2 Managing EmployeePresident and Ceo May 27, 2001
Andrew S Mendelson Individual Corporate OfficerVice Chair Jan 27, 2005
Ralph a Nappi Individual Corporate DirectorBoard Member Jan 1, 2018
J Gordon Huszagh Individual Corporate Officer2ND Vice Chair Jan 27, 1992
Michele L Cusack Individual Corporate OfficerSenior Vice President & Cfo Jan 15, 2016
Operational/Managerial ControlSenior Vice President & Cfo Jan 15, 2016

Owners & managing parties with NPI records 2

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

Facilities with the same owner 28

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 28

Practitioners & affiliated clinicians

Affiliated clinicians 348

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

View all 348

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1932155678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012031",
            "telephone_number": "631-548-6000",
            "fax_number": "631-548-6397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ROANOKE AVE",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012031",
            "telephone_number": "631-548-6000",
            "fax_number": "631-548-6397"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "755 New York Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "NY",
            "postal_code": "117434240",
            "country_code": "US",
            "telephone_number": "631-548-6432",
            "fax_number": "631-548-6435",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Heroes Way",
            "address_purpose": "LOCATION",
            "city": "Riverhead",
            "state": "NY",
            "postal_code": "119012054",
            "country_code": "US",
            "telephone_number": "631-548-6432",
            "fax_number": "631-548-6435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTRAL SUFFOLK HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "516-321-6058",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NY",
            "license": "5155601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00274328",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03000300",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000250-7",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peconic Bay Homehealth Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peconic Bay Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverhead, NY

Sources for this page

Verify at the official NPI Registry.