ACTIVE LIFE HEALTH OF NY PC
NPI 1275814105
General Practice in Smithtown, NY
About Active Life Health Of Ny Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ACTIVE LIFE HEALTH OF NY PC (NPI 1275814105) is a healthcare organization registered as a general practice in Smithtown, New York and active in the NPI registry since September 2011. The organization maintains 2 additional practice locations and lists John J Rush, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Active Life Health Of Ny Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
7Medicare enrollment records show 7 clinicians reassign Medicare billing to Active Life Health Of Ny PC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (7)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Active Life Health Of Ny PC's NPI number?
The NPI number for Active Life Health Of Ny PC is 1275814105. It was assigned to this organization in the NPPES registry on September 6, 2011.
Where is Active Life Health Of Ny PC located?
Active Life Health Of Ny PC is located at 300 E Main St Ste 1, Smithtown, NY 11787. The listed phone number is (631) 656-8796.
What is Active Life Health Of Ny PC's specialty?
The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.
Is Active Life Health Of Ny PC enrolled in Medicare?
Yes. Active Life Health Of Ny PC is registered in the Medicare PECOS enrollment system.
When is Active Life Health Of Ny PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New York, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Active Life Health Of Ny PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 5 Medicare specialties reassign their Medicare billing to Active Life Health Of Ny PC. A 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 the clinician's services. The largest specialties are Diagnostic Radiology (3), Emergency Medicine (1) and Family Practice (1). Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Active Life Health Of Ny PC was last updated on March 4, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Active Life Health Of Ny Pc · NPI 1275814105
General Practice organization in Smithtown, New York. Organization record, active in the CMS NPPES registry since September 6, 2011.
## Identity
- **NPI:** 1275814105 (Entity type: Organization)
- **Enumerated:** September 6, 2011
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **Organization subpart:** No
- **Authorized official:** John Rush, OWNER
## Practice location
- **Address:** 300 E MAIN ST STE 1, Smithtown, NY 11787-2900
- **Phone:** (631) 656-8796 · **Fax:** (631) 333-7322
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, New York, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 7 clinicians in 5 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Diagnostic Radiology (3), Emergency Medicine (1), Family Practice (1); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 4, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1275814105) · Data from the CMS NPPES public registry.