Individual provider Active NPI

Garrett Dejesus, M.D.

  • Diagnostic Radiology Physician
  • Buffalo, NY
National Provider Identifier
1104192301
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
318683 Issued in NY
Practice address
Elm and Carlton St
Buffalo, NY 14263-0001
Phone
(716) 845-2300
NPI assigned
Apr 2, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 318683 NY Primary
Diagnostic Radiology Physician 2085R0202X A130608 CA
Diagnostic Radiology Physician 2085R0202X MD6084084 WA

Addresses

Primary practice location

Elm and Carlton St
Buffalo, NY 14263-0001

Mailing address

Elm and Carlton St
Buffalo, NY 14263-0001
Phone (716) 845-2300

Other practice location 1

101 The City Dr S
Orange, CA 92868-3201
Phone (714) 456-8888

Other identifiers 1

IdentifierTypeStateIssuer
0000000MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY, NJ3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20170705001349 CA Practitioner - Diagnostic Radiology 6608145776 Reassigns benefits to 1 organization
I20230327000813 NY Practitioner - Diagnostic Radiology 6608145776 Reassigns benefits to 5 organizations
I20231109002615 NJ Practitioner - Diagnostic Radiology 6608145776 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Albert Einstein College of Medicine of Yeshiva University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
UC RegentsGroup PAC ID 3274446182, 105 clinicians
Roswell Park Cancer InstituteGroup PAC ID 3577475110, 487 clinicians

Practice addresses (Care Compare)

101 The City Dr S
Orange, CA 92868-3201
Phone (714) 456-7004

Elm and Carlton St
Buffalo, NY 14263-0001
Phone (716) 845-2300

Hospital & facility affiliations

  • Roswell Park Cancer Institute Hospital, Buffalo, NY, CCN 330354
  • Uci Health-Orange Hospital, Orange, CA, CCN 050348

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A130608CAMDDiagnostic Radiology Physician
318683NYMDDiagnostic Radiology Physician
MD6084084WAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Medical PC CurrentSince Mar 1, 2025 Accepting new patients
A.G. Dikengil, MD, PA CurrentSince Oct 1, 2023 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Oct 1, 2023 Accepting new patients
UC Regents Diagnostic Radiology CurrentSince Dec 15, 2025 Accepting new patients
Optum Medical Care, P.C. CurrentSince Jan 16, 2023 Accepting new patients
Roswell Park Cancer Institute CurrentSince Jul 15, 2024 Accepting new patients
Optum Medical Care, P.C. Diagnostic Radiology CurrentSince Jan 16, 2023 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Oct 1, 2023 Accepting new patients
Scripps Health Current Accepting new patients
North Shore-Lij Medical PC CurrentSince Mar 1, 2025 Accepting new patients
Optum Urgent Care, PLLC CurrentSince Mar 1, 2025 Accepting new patients
UC Regents Diagnostic Radiology CurrentSince Dec 15, 2025 Accepting new patients
Roswell Park Cancer Institute CurrentSince Jul 15, 2024 Accepting new patients
Southside Faculty Medical Affiliates University Faculty Practice Corp CurrentSince Mar 1, 2025 Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

736 Page Ave
Lyndhurst, NJ 07071
Phone (201) 531-9006

1 Harmon Plz
Fl 10
Secaucus, NJ 07094
Phone (201) 636-7233

2322 30th Ave
Astoria, NY 11102
Phone (718) 267-2763

Elm and Carlton St
Buffalo, NY 14263

Dept 8000
Buffalo, NY 14267

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

555 N Broadway
Jericho, NY 11753
Phone (516) 597-5070

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

1421 3rd Ave
New York, NY 10028
Phone (212) 744-5538

300 Community Dr
Plandome, NY 11030

9525 Queens Blvd
Frnt 2
Rego Park, NY 11374
Phone (718) 360-5522

1220 Hicksville Rd
Seaford, NY 11783

Philadelphia, PA 19195

Networks

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

Interoperability endpoints

  • Direct secure messaging: gdejesus87747@direct.optum.com
  • Direct secure messaging: gdejesus286625@scrippshlth.medalliesdirect.net

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 3

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": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765411200000",
    "number": "1104192301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ELM AND CARLTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142630001",
            "telephone_number": "716-845-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ELM AND CARLTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142630001",
            "telephone_number": "716-845-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 The City Dr S",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928683201",
            "country_code": "US",
            "telephone_number": "714-456-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEJESUS",
        "first_name": "GARRETT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-02",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "318683",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A130608",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "MD6084084",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000000",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.