Individual provider Active NPI

Diane Cicatello, MD

  • Pediatrics Physician
  • Poughkeepsie, NY
National Provider Identifier
1023070778
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
186530 Issued in NY
Practice address
30 Columbia St
Poughkeepsie, NY 12601-3906
Phone
(845) 231-5600
Fax
(845) 592-7710
NPI assigned
Apr 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 186530 NY Primary

Addresses

Primary practice location

30 Columbia St
Poughkeepsie, NY 12601-3906

Mailing address

110 S Bedford Rd
Caremount Medical PC
Mount Kisco, NY 10549-3446
Phone (914) 241-1050

Other identifiers 1

IdentifierTypeStateIssuer
01890922MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101129000570 NY Practitioner - Pediatric Medicine 3173719440 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
186530NYMDPediatrics Physician

Practice roles (3 of 7)

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Jan 1, 2015 Accepting new patients
Optum Medical Care, P.C. CurrentSince Jan 1, 2015 Accepting new patients
Mount Kisco Medical Group Past Accepting new patients

Locations

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

2507 South Rd
Poughkeepsie, NY 12601
Phone (845) 471-2287

30 Columbia St
Poughkeepsie, NY 12601
Phone (845) 483-5934

Philadelphia, PA 19195

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479254400000",
    "number": "1023070778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S BEDFORD RD",
            "address_2": "CAREMOUNT MEDICAL PC",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105493446",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 COLUMBIA ST",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126013906",
            "telephone_number": "845-231-5600",
            "fax_number": "845-592-7710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICATELLO",
        "first_name": "DIANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2016-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "186530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01890922",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

Verify at the official NPI Registry.