NPIMap

Organization Active NPI

North Shore Medical Group of the Mount Sinai School of Medicine

  • Gastroenterology Physician
  • Nesconset, NY
National Provider Identifier
1962646091
Registry record updated Nov 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE
Practice address
59 Southern Blvd
Nesconset, NY 11767-1090
Phone
(631) 659-1700
Fax
(631) 659-1750
NPI assigned
Apr 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2012

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

Authorized official

Name
Ms. Janet Street
Title
Practice Administrator
Phone
(631) 351-3703

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

59 Southern Blvd
Nesconset, NY 11767-1090

Mailing address

59 Southern Blvd
Nesconset, NY 11767-1090
Phone (631) 659-1700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000412 NY Part B Supplier - Clinic/Group Practice 8921999087 Receives reassigned benefits from 579 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
North Shore Medical Group10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

19 E Main St
Ste 2
Bay Shore, NY 11706
Phone (631) 665-6393

Ownership & related parties

Other NPIs on the same Medicare enrollment 8

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

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352332800000",
    "number": "1962646091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 SOUTHERN BLVD",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117671090",
            "telephone_number": "631-659-1700",
            "fax_number": "631-659-1750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 SOUTHERN BLVD",
            "city": "NESCONSET",
            "state": "NY",
            "postal_code": "117671090",
            "telephone_number": "631-659-1700",
            "fax_number": "631-659-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-20",
        "last_updated": "2012-11-08",
        "status": "A",
        "authorized_official_last_name": "STREET",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "631-351-3703",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nesconset, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.