DR. MICHAEL JIN (MD) – Diagnostic Radiology Physician, NPI 1063972511
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,685 DIAGNOSTIC RADIOLOGY in NY
Provider Addresses for DR. MICHAEL JIN (MD)
17806 WELLINGTON CREST CT
WILDWOOD, MO 630056340
Phone: (919) 723-7648
Fax: (631) 444-2493
Type: Mailing
DEPT OF MEDICINE HSC LEVEL 16 SUNY STONY BROOK HOSPITAL
STONY BROOK, NY 117940001
Phone: (631) 444-2058
Fax: (631) 444-2058
Type: Location
2809 OCEAN PKWY
BROOKLYN, NY 112357802
Phone: (347) 713-5234
Fax: (631) 444-2493
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-04-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250428000390 | I | Diagnostic Radiology | NC | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 63005)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Diagnostic Radiology | GA | |
| - | SC | |
| - | SC | |
| Diagnostic Radiology | NC | |
| Diagnostic Radiology, Neurology | NC | |
| Certified Registered Nurse Anesthetist (Crna) | VA | |
| Diagnostic Radiology | NC | |
| Qualified Audiologist | NC | |
| Diagnostic Radiology | NH | |
| Diagnostic Radiology, Interventional Radiology | MO |
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