HALEY ANN KETCHAM FNP
NPI 1174280903
Nurse Practitioner - Family in Hampton Bays, NY
About Haley Ann Ketcham Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
HALEY ANN KETCHAM FNP (NPI 1174280903) is an individual family provider in Hampton Bays, New York, licensed in New York (F348701) and active in the NPI registry since November 2021. She is enrolled in Medicare PECOS, is affiliated with Peconic Bay Medical Center, and is a graduate of State University Of New York Downstate Medical Center (2021).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Haley Ann Ketcham Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Haley Ketcham reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
West Islip, NY 11795
- Reassigned Medicare billing, New York enrollment
- Medicare enrollment name: Samaritan Medical Services PC
- 209 clinicians in this Medicare group
Great Neck, NY 11021
- Reassigned Medicare billing, New York enrollment
- 9,353 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Peconic Bay Medical Center
Acute Care Hospitals · Riverhead, NYSuny/Stony Brook University Hospital
Acute Care Hospitals · Stony Brook, NYPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 11946 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Haley Ketcham's NPI number?
The NPI number for Haley Ketcham is 1174280903. It was assigned to this individual provider in the NPPES registry on November 29, 2021.
Where is Haley Ketcham located?
Haley Ketcham practices at 6 Long Ln, Hampton Bays, NY 11946. The listed phone number is (631) 566-5217.
What is Haley Ketcham's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Haley Ketcham enrolled in Medicare?
Yes. Haley Ketcham is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Haley Ketcham's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Haley Ketcham reassigns Medicare benefits to 2 organizations: Samaritan Medical Services, P.C. (West Islip, NY) and North Shore-Lij Medical PC (Great Neck, NY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Haley Ketcham's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Haley Ketcham affiliated with any hospitals?
According to CMS data, Haley Ketcham is affiliated with Peconic Bay Medical Center and Suny/Stony Brook University Hospital.
When was this NPI record last updated?
The NPPES record for Haley Ketcham was last updated on November 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Haley Ann Ketcham, FNP · NPI 1174280903
Family physician in Hampton Bays, New York. Individual provider, active in the CMS NPPES registry since November 29, 2021.
## Identity
- **NPI:** 1174280903 (Entity type: Individual)
- **Enumerated:** November 29, 2021
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** F348701 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 6 LONG LN, Hampton Bays, NY 11946-2641
- **Phone:** (631) 566-5217
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Samaritan Medical Services, P.C. (NPI 1124184544, West Islip, NY); North Shore-Lij Medical PC (NPI 1053688572, Great Neck, NY) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** State University Of New York Downstate Medical Center, class of 2021
## Record status
- **NPPES last updated:** November 29, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1174280903) · Data from the CMS NPPES public registry.