Individual provider Active NPI

Anish Desai, MD

  • Pulmonary Disease Physician
  • Port Jefferson Station, NY
National Provider Identifier
1093050007
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
280824 Issued in NY
Practice address
1500 Route 112 Ste B
Port Jefferson Station, NY 11776-8054
Phone
(631) 978-7633
Fax
(631) 621-4119
NPI assigned
Dec 2, 2012
Last updated
Apr 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 280824 NY Primary

Addresses

Primary practice location

1500 Route 112 Ste B
Port Jefferson Station, NY 11776-8054

Mailing address

1500 Route 112 Ste B
Port Jefferson Station, NY 11776-8054
Phone (631) 978-7633

Other practice location 1

200 Motor Pkwy Ste C-16
Hauppauge, NY 11788-5114
Phone (631) 978-7633

Other identifiers 1

IdentifierTypeStateIssuer
04494735MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address adesai@nsc.direct.gemmsnet.com Direct

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
I20160823002759 NY Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 4789979212 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-1750

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-0580

26 Research Way
East Setauket, NY 11733-3526
Phone (631) 444-0580

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in Pulmonary Disease CurrentSince Jul 1, 2016 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Pulmonary Disease CurrentSince Jan 27, 2020 Accepting new patients
Department of Medicine Medical Service Group CurrentSince Jul 1, 2016 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Jan 27, 2020 Accepting new patients
Upstate Community Medical, PC CurrentSince Dec 1, 2018 Accepting new patients
University Hospital at Stony Brook Past Accepting new patients

Locations

200 Motor Pkwy
Ste C16
Hauppauge, NY 11788
Phone (631) 638-4933

1500 Route 112
Ste B
Port Jefferson Station, NY 11776
Phone (631) 343-4184

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

100 Nicolls Rd
#13202
Stony Brook, NY 11794

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

4900 Broad Rd
Syracuse, NY 13215
Phone (315) 492-5011

4900 Broad Rd
Ste 4H
Syracuse, NY 13215
Phone (315) 492-5678

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

90 Presidential Plz
Syracuse, NY 13202
Phone (315) 464-3836

90 Presidential Plz
Fl 2
Syracuse, NY 13202
Phone (315) 464-3833

Networks

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

Organizations & group practices 6

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

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1354406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1093050007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112 STE B",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768054",
            "telephone_number": "631-978-7633",
            "fax_number": "631-686-2578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112 STE B",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768054",
            "telephone_number": "631-978-7633",
            "fax_number": "631-621-4119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Motor Pkwy Ste C-16",
            "address_purpose": "LOCATION",
            "city": "Hauppauge",
            "state": "NY",
            "postal_code": "117885114",
            "country_code": "US",
            "telephone_number": "631-978-7633",
            "fax_number": "631-621-4115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESAI",
        "first_name": "ANISH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-02",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "280824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04494735",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adesai@nsc.direct.gemmsnet.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1500 Route 112 Ste B",
            "city": "Port Jefferson Station",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117768054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

Verify at the official NPI Registry.