Active NPI 1093724239 Individual Practitioner Male Practitioner

Dr. Jack Philip Tom , MD

Dermatology • Stony Brook, NY

Professional Overview & Biography Verified Profile Summary

Dr. Jack Tom, MD is a registered healthcare professional specializing in Dermatology in Stony Brook, NY. Practice services are available at 207 HALLOCK RD under active NPI credentials.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, tangential biopsy of single skin lesion. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

207 Hallock Rd
Suite 211

Stony Brook, NY 117903033

Telephone 6314440004

Fax 6314440088

Associated Practice Facility / Clinic

🏢 Island Wide Medical Health Services. Pc Facility NPI 1720014277

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Stony Brook, NY

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 22.6 Yrs

State Avg: 28.4 Yrs

Regional Practice Density

9 Specialists

Practicing in Stony Brook, NY (1289 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

59.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2021)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,259	213	$50.00	$7.80
99213 Established patient office or other outpatient visit, typically 15 minutes	811	514	$200.31	$109.82
11102 Tangential biopsy of single skin lesion	545	397	$350.00	$124.88
11103 Biopsy of related skin growth, each additional growth	382	173	$175.00	$65.86
17000 Destruction of skin growth	371	281	$300.00	$59.33
17004 Destruction of precancer skin growth, 15 or more growths	207	132	$374.88	$205.22
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	196	157	$234.57	$155.82
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	186	153	$151.88	$67.82
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	135	70	$10.00	$1.28
11900 Injection into skin growth, 1-7 growths	66	52	$225.00	$49.16
11901 Injection into skin growth, more than 7 growths	54	19	$225.00	$78.69
17110 Destruction of up to 14 skin growths	44	37	$500.00	$137.68
69100 Biopsy of ear	39	33	$350.00	$90.48
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	35	27	$350.00	$205.08
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	11	11	$350.00	$201.63

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	995	197	$50.00	$7.17
99213 Established patient office or other outpatient visit, typically 15 minutes	518	401	$195.00	$89.69
11102 Tangential biopsy of single skin lesion	508	384	$350.00	$118.38
11103 Biopsy of related skin growth, each additional growth	362	166	$175.00	$65.50
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	349	314	$225.00	$129.36
17000 Destruction of skin growth	331	272	$300.00	$58.50
17004 Destruction of precancer skin growth, 15 or more growths	199	126	$375.00	$191.71
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	182	144	$150.00	$55.22
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	86	36	$10.00	$1.45
17110 Destruction of up to 14 skin growths	55	43	$500.00	$137.51
11901 Injection into skin growth, more than 7 growths	40	16	$225.00	$78.84
11900 Injection into skin growth, 1-7 growths	39	28	$225.00	$52.44
69100 Biopsy of ear	38	30	$350.00	$85.75
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	36	27	$350.00	$197.62
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	14	13	$350.00	$133.23

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,839	312	$50.00	$6.92
11102 Tangential biopsy of single skin lesion	693	495	$350.00	$115.65
99213 Established patient office or other outpatient visit, typically 15 minutes	666	519	$195.00	$86.12
17000 Destruction of skin growth	565	411	$300.00	$60.70
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	445	378	$225.00	$125.41
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	392	266	$150.00	$52.82
11103 Biopsy of related skin growth, each additional growth	365	191	$175.00	$63.86
17004 Destruction of precancer skin growth, 15 or more growths	228	136	$375.00	$182.71
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	178	64	$10.00	$1.59
11901 Injection into skin growth, more than 7 growths	74	20	$225.00	$78.57
17110 Destruction of up to 14 skin growths	66	45	$500.00	$130.07
11900 Injection into skin growth, 1-7 growths	64	40	$225.00	$50.95
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	35	32	$350.00	$206.36
69100 Biopsy of ear	27	25	$350.00	$87.63
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	26	19	$750.00	$390.36
96573 Application of light by qualified health care professional to destroy precancer skin growth	23	17	$350.00	$242.05
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	20	18	$350.00	$152.47
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	13	13	$250.00	$126.94

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,665	283	$50.00	$6.31
11100 Biopsy of single growth of skin and/or tissue	776	562	$350.00	$120.21
99213 Established patient office or other outpatient visit, typically 15 minutes	697	543	$195.00	$81.88
17000 Destruction of skin growth	527	402	$300.00	$58.88
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	468	311	$150.00	$50.02
11101 Biopsy of each additional growth of skin and/or tissue	465	238	$175.00	$38.14
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	433	371	$225.00	$120.79
17004 Destruction of precancer skin growth, 15 or more growths	265	157	$375.00	$168.12
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	130	60	$10.00	$1.78
11901 Injection into skin growth, more than 7 growths	74	23	$225.00	$76.29
17110 Destruction of up to 14 skin growths	54	43	$500.00	$127.63
11900 Injection into skin growth, 1-7 growths	46	39	$225.00	$50.76
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	22	13	$750.00	$398.12
69100 Biopsy of ear	21	18	$350.00	$81.37
96573 Application of light by qualified health care professional to destroy precancer skin growth	21	13	$350.00	$220.61
99202 New patient office or other outpatient visit, typically 20 minutes	20	20	$225.00	$85.47
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	18	18	$350.00	$143.41
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	18	17	$350.00	$199.69
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	12	12	$250.00	$123.53
10040 Acne surgery	12	12	$325.00	$128.77

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,756	309	$33.91	$6.75
99213 Established patient office or other outpatient visit, typically 15 minutes	940	698	$127.95	$82.01
11100 Biopsy of single growth of skin and/or tissue	923	647	$225.84	$117.80
11101 Biopsy of each additional growth of skin and/or tissue	673	317	$110.07	$38.00
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	600	367	$100.36	$49.60
17000 Destruction of skin growth	551	413	$191.47	$55.46
17004 Destruction of precancer skin growth, 15 or more growths	281	158	$302.05	$174.72
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	265	241	$182.70	$119.73
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	151	68	$9.67	$1.76
11900 Injection into skin growth, 1-7 growths	68	47	$124.71	$50.63
11901 Injection into skin growth, more than 7 growths	65	23	$156.46	$74.72
17110 Destruction of up to 14 skin growths	53	28	$275.47	$124.35
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	45	34	$263.33	$148.93
69100 Biopsy of ear	38	34	$185.92	$84.98
99202 New patient office or other outpatient visit, typically 20 minutes	38	38	$168.16	$85.30
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	34	23	$327.94	$159.50
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	33	23	$507.58	$350.43
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	23	22	$302.17	$195.74
99201 New patient office or other outpatient visit, typically 10 minutes	21	21	$90.71	$50.49
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	21	21	$210.00	$124.15
10040 Acne surgery	16	14	$225.00	$119.17
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	13	11	$276.92	$160.29

Medical Specialties & State Licenses

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License NY 155342

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

01711760 (NY)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

35 Associated Practitioners

Jean Cassmer , RN

Registered Nurse

NPI 1013249960

Registered Nurse

Julia Swierupski

Speech-Language Pathologist

NPI 1134813926

Joanne Fariello , LPN

Home Health

NPI 1164754461

Licensed Practical Nurse

Dr. Alexander Benitt , MD

Pediatrics

NPI 1184684466

Doctor of Medicine (M.D.)

Maryann Logalbo , RN

Registered Nurse

NPI 1194048454

Registered Nurse

Kelly Strigaro

Speech-Language Pathologist

NPI 1205722261

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 207 HALLOCK RD, SUITE 211, STONY BROOK, NY 117903033 (Tel: 6314440004)

📍

Updated Business Mailing Address July 08, 2007

Registered at 207 HALLOCK RD, SUITE 211, STONY BROOK, NY 117903033 (Tel: 6314440004)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as JACK TOM, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dermatology (License #155342 in NY)

🟢

Initial NPI Registration & Enumeration August 05, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1093724239

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: August 05, 2006

Last Update: July 08, 2007

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

207 Hallock Rd, Suite 211

Stony Brook, NY 117903033

Phone: 6314440004

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.