NPIMap

Organization Active NPI

Good Shepherd Hospice

  • Hospice and Palliative Medicine (Anesthesiology) Physician
  • Farmingdale, NY
National Provider Identifier
1992131635
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Anesthesiology) PhysicianTaxonomy code 207LH0002X
Legal business name
GOOD SHEPHERD HOSPICE
Practice address
110 Bi County Blvd
Farmingdale, NY 11735-3943
Phone
(631) 828-7415
Fax
(631) 828-7494
NPI assigned
Sep 25, 2013
Last updated
Sep 28, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
GOOD SHEPHERD HOSPICEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
Dr. Kerrianne P Page, MD
Title
Chief Medical Officer
Phone
(631) 465-6300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Anesthesiology) Physician 207LH0002X NU Primary

Addresses

Primary practice location

110 Bi County Blvd
Farmingdale, NY 11735-3943

Mailing address

110 Bi County Blvd
Farmingdale, NY 11735-3943
Phone (631) 828-7415

Other names 1

  • Good Shepherd Physicians Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160120002079 NY Part B Supplier - Clinic/Group Practice 1759281843 Receives reassigned benefits from 23 practitioners
Practice locations: Farmingdale, NY

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Good Shepherd Hospice2 organizations share this tax ID, including this one
Part of
Good Shepherd Hospice

Other organizations with this tax ID 1

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

Locations

110 Bi County Blvd
Ste 114
Farmingdale, NY 11735
Phone (631) 465-6300

190 Motor Pkwy
Hauppauge, NY 11788
Phone (631) 648-1255

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

4747 Nesconset Hwy
Unit 20
Port Jefferson Station, NY 11776
Phone (631) 474-5500

110 Bi County Blvd
South Farmingdale, NY 11735
Phone (631) 465-6300

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1380067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1992131635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BI COUNTY BLVD",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117353943",
            "telephone_number": "631-828-7415",
            "fax_number": "631-828-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BI COUNTY BLVD",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117353943",
            "telephone_number": "631-828-7415",
            "fax_number": "631-828-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HOSPICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SHEPHERD HOSPICE",
        "enumeration_date": "2013-09-25",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "PAGE",
        "authorized_official_first_name": "KERRIANNE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "631-465-6300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LH0002X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Physicians",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Good Shepherd Physicians",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Farmingdale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; 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.