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SAME
NPI 1487620613
Internal Medicine in Mattituck, NY

Active since February 27, 2006CLIA Certified · 6 labs
13400 MAIN RD, MATTITUCK, NY 11952(631) 298-4008(631) 298-5969 Get Directions Write a Review

NPPES record last updated: May 20, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Same NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAME (NPI 1487620613) is a healthcare organization registered as an internal medicine in Mattituck, New York and active in the NPI registry since February 2006. The organization holds 6 active CLIA laboratory certificates and lists Michael O'donnell, Cfo, as its authorized official.

NPPES Registry Identity

NPI1487620613
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NamePECONIC BAY PRIMARY MEDICAL CARE
Location Address13400 MAIN RDMattituck, NY 11952-3209
Mailing AddressPo Box 2377Riverhead, NY 11901-2108 · (631) 298-4479 · Fax (631) 591-3047
Phone(631) 298-4008
Fax(631) 298-5969
Organization SubpartNo
Authorized OfficialMichael O'donnellCfo · (631) 298-4479
Enumeration DateFebruary 27, 2006
Last NPPES UpdateMay 20, 2024
✔ NPI 1487620613 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
13400 MAIN RD, Mattituck, NY 11952
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Other Names 1

Doing Business AsSame

Other Identifiers 1

Medicaid01714209NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 6

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2064438

Peconic Bay Primary Medical Care PC · Manorville, NY
Active · expires Mar 26, 2027
CLIA Number33D2064438
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateAugust 20, 2013
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Richard Kubiak
Laboratory Phone(631) 298-4479
Laboratory LocationPeconic Bay Primary Medical Care PC496 County Rd - Suite 111, Manorville, NY 11949
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 33D2184908

Peconic Bay Primary Medical Care PC · Greenport, NY
Active · expires Mar 26, 2027
CLIA Number33D2184908
Laboratory TypePhysician Office
Certificate Effective DateMay 27, 2020
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Luigi Buono
Laboratory Phone(631) 298-4479
Laboratory LocationPeconic Bay Primary Medical Care PC230 Main St, Greenport, NY 11944
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 33D0160645

Peconic Bay Primary Medical Care PC · Mattituck, NY
Active · expires Mar 26, 2027
CLIA Number33D0160645
Laboratory TypePhysician Office
Certificate Effective DateApril 7, 2016
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Luigi Buono
Laboratory Phone(631) 298-2030
Laboratory LocationPeconic Bay Primary Medical Care PC7905 Main Road, Mattituck, NY 11952
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 33D2111220

Peconic Bay Primary Medical Care PC · Riverhead, NY
Active · expires Mar 26, 2027
CLIA Number33D2111220
Laboratory TypePhysician Office
Certificate Effective DateApril 1, 2016
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Devashree Parmar
Laboratory Phone(631) 722-4200
Laboratory LocationPeconic Bay Primary Medical Care PC31 Main Road, Riverhead, NY 11901
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 33D2111221

Peconic Bay Primary Medical Care PC · Riverhead, NY
Active · expires Mar 26, 2027
CLIA Number33D2111221
Laboratory TypePhysician Office
Certificate Effective DateApril 1, 2026
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Evan Nadal
Laboratory Phone(631) 284-9250
Laboratory LocationPeconic Bay Primary Medical Care PC34 Commerce Drive, Riverhead, NY 11901
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 33D2166721

Peconic Bay Primary Medical Care PC · Riverhead, NY
Active · expires Mar 26, 2027
CLIA Number33D2166721
Laboratory TypePhysician Office
Certificate Effective DateMay 23, 2019
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Rajeev B. Patel
Laboratory Phone(631) 727-1818
Laboratory LocationPeconic Bay Primary Medical Care PC1333 Roanoke Ave - Suite 202, Riverhead, NY 11901
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOHN IMPELLIZERI D.O
Internal Medicine
13400 MAIN RD
MATTITUCK, NY 11952
Suffolk County (631) 298-4008

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 Peconic Bay Primary Medical Care's NPI number?

The NPI number for Peconic Bay Primary Medical Care is 1487620613. It was assigned to this organization in the NPPES registry on February 27, 2006. The provider is doing business as Same.

Where is Peconic Bay Primary Medical Care located?

Peconic Bay Primary Medical Care is located at 13400 Main Rd, Mattituck, NY 11952. The listed phone number is (631) 298-4008.

What is Peconic Bay Primary Medical Care's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Peconic Bay Primary Medical Care hold CLIA laboratory certificates?

Yes. 6 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Peconic Bay Primary Medical Care was last updated on May 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.