Damien Anthony Decollibus, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

010067 Issued in NY

Practice address

100 E 77TH St
Division of Vascular Surgery
New York, NY 10075-1850

Phone

(212) 434-4264

Fax

(212) 434-4231

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

State University of New York at Stony Brook, School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• VNS of Ny Home Care Chha Home health agency, New York, NY, CCN 337008
• Lenox Hill Hospital Hospital, New York, NY, CCN 330119

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles (6 of 10)

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: ddecollibus24696@northwell.direct-ci.com

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment Care Compare group
• North Shore-Lij Medical Group at Huntington PC

  • Vascular Surgery Physician
  • New Hyde Park, NY
  • NPI 1174147979
  Medicare reassignment NPD
• St. Francis Hospital

  • General Acute Care Hospital
  • Roslyn, NY
  • NPI 1760704811
  Medicare reassignment
• Mercy Medical Center

  • Psychiatric Hospital Unit
  • Rockville Centre, NY
  • NPI 1427017854
  NPD
• North Shore - Lij Medical PC

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD
• St Francis Hospital United States Catholic Conference

  • General Acute Care Hospital
  • Roslyn, NY
  • NPI 1750439030
  NPD
• St. Francis Hospital

  • Cardiovascular Disease Physician
  • West Islip, NY
  • NPI 1528386810
  NPD
• Park Lenox Surgical, PC

  • Vascular Surgery Physician
  • New York, NY
  • NPI 1992861652
  NPD (past)

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

• Lenox Hill Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1477616571
  Care Compare affiliation
• Visiting Nurse Service of New York Home Care II

  • Home Health Agency
  • New York, NY
  • NPI 1528059805
  Care Compare affiliation

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221004800000",
    "number": "1114009115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E 77TH ST",
            "address_2": "DIVISION OF VASCULAR SURGERY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751850",
            "telephone_number": "212-434-4264",
            "fax_number": "212-434-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 77TH ST",
            "address_2": "DIVISION OF VASCULAR SURGERY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751850",
            "telephone_number": "212-434-4264",
            "fax_number": "212-434-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECOLLIBUS",
        "first_name": "DAMIEN",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2008-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "010067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00246075",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa A Declemente, O.D.
• Simone Sonia Declercq, L.AC.
• Brittany Cherie Declouette
• Emily Decola
• Dana Decolator, LMSW
• Anna Decolongon, PHARM D.
• Jeannie Decoo, RPA-C
• Douglas R Decorato, M.D.
• Louise Decosta, PH.D., L.C.S.W.
• Decotiis Medical LLC

• Surgical Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.