DEER PARK SOUTH SHORE PODIATRY PC
NPI 1821765736
Clinic/Center - Podiatric in North Babylon, NY
About Deer Park South Shore Podiatry Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DEER PARK SOUTH SHORE PODIATRY PC (NPI 1821765736) is a healthcare organization registered as a podiatric in North Babylon, New York and active in the NPI registry since August 2021. The organization lists Ronald Kim, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Deer Park South Shore Podiatry Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Deer Park South Shore Podiatry PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 Deer Park South Shore Podiatry PC's NPI number?
The NPI number for Deer Park South Shore Podiatry PC is 1821765736. It was assigned to this organization in the NPPES registry on August 27, 2021.
Where is Deer Park South Shore Podiatry PC located?
Deer Park South Shore Podiatry PC is located at 1428 Deer Park Ave, North Babylon, NY 11703. The listed phone number is (631) 586-3388.
What is Deer Park South Shore Podiatry PC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Podiatric, with taxonomy code 261QP1100X.
Is Deer Park South Shore Podiatry PC enrolled in Medicare?
Yes. Deer Park South Shore Podiatry PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Deer Park South Shore Podiatry PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Podiatry) reassigns their Medicare billing to Deer Park South Shore Podiatry 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Deer Park South Shore Podiatry PC was last updated on August 27, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Deer Park South Shore Podiatry Pc · NPI 1821765736
Podiatric organization in North Babylon, New York. Organization record, active in the CMS NPPES registry since August 27, 2021.
## Identity
- **NPI:** 1821765736 (Entity type: Organization)
- **Enumerated:** August 27, 2021
- **Primary specialty:** Clinic/Center - Podiatric · taxonomy 261QP1100X
- **Organization subpart:** No
- **Authorized official:** Ronald Kim, OWNER
## Practice location
- **Address:** 1428 DEER PARK AVE, North Babylon, NY 11703-1623
- **Phone:** (631) 586-3388 · **Fax:** (631) 586-3394
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Podiatry) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 27, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1821765736) · Data from the CMS NPPES public registry.