Damien T Faillace, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

014579 Issued in NY

Practice address

707 E Main St
Middletown, NY 10940-2650

Phone

(845) 333-7575

Fax

(845) 333-1454

NPI assigned

Jan 28, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: dafaillace@montefioredirect.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.

• Orthopedic Assoc of Dutchess County P C

  • Orthopaedic Surgery Physician
  • Poughkeepsie, NY
  • NPI 1386661452
  Medicare reassignment
• Orthopedic Assoc of Dutchess County P C

  • Orthopaedic Surgery Physician
  • New Windsor, NY
  • NPI 1396049797
  NPD
• Orthopedic Assoc of Dutchess County P C

  • Orthopaedic Surgery Physician
  • Kingston, NY
  • NPI 1588681662

  Physician Assistant

  NPD
• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  NPD (past)
• Orangetown Orthopedic Associates,LLP

  • Specialist
  • Orangeburg, NY
  • NPI 1679690218
  NPD (past)

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

{
    "created_epoch": "1296172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523836800000",
    "number": "1164728838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-7575",
            "fax_number": "845-333-1454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-7575",
            "fax_number": "845-333-1454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAILLACE",
        "first_name": "DAMIEN",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-28",
        "last_updated": "2018-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014579",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "014579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03656622",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Korey D. Evans, PA-C
• Exceldent of Orange/Sullivan, LLP
• Exclusive PT PC
• Eye to Eye Vision Center
• Kanayo Eze, NP
• Kelly-Ann Monique Fairweather, LMSW
• Brenda Fajarda, RPH
• Marissa Fajardo
• Kisha Marie Falcon
• Justin Michael Fallacaro, PA-C

• Surgical Physician Assistant in Middletown, NY
• Providers in Middletown, 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 Apr 16, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.