Theodore Raymond Dage, ACPNP, DNP

Primary specialty

Critical Care Pediatric Nurse PractitionerTaxonomy code 363LP0222X

License

382855 Issued in NY

Practice address

707 E Main St
Middletown, NY 10940-2650

Phone

(845) 333-1000

NPI assigned

Jan 17, 2018

Last updated

Jul 13, 2022By the provider in NPPES

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

Electronic endpoints 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

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: tdage60208@direct.garnethealth.org

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.

• Garnet Health Doctors PC

  • General Practice Physician
  • Middletown, NY
  • NPI 1093138851
  Medicare reassignment NPD
• Garnet Health Medical Center

  • General Acute Care Hospital
  • Middletown, NY
  • NPI 1609875772
  NPD (past)

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

{
    "created_epoch": "1516147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1205344868",
    "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": "845-333-3370",
            "fax_number": "845-333-3372"
        },
        {
            "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": "845-333-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "217 Pine Island Tpke",
            "address_purpose": "LOCATION",
            "city": "Warwick",
            "state": "NY",
            "postal_code": "109902514",
            "country_code": "US",
            "telephone_number": "716-790-3069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAGE",
        "first_name": "THEODORE",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "ACPNP, DNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-17",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "NY",
            "license": "382855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tdage60208@direct.garnethealth.org",
            "affiliation": "Y",
            "affiliationName": "Garnet Health Doctors PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "707 E Main St",
            "city": "Middletown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "109402650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• CVS Albany LLC (CVS Pharmacy# 10009)
• CVS Albany LLC (CVS Pharmacy# 02361)
• Maxime Cyprien
• Rhonda Lynn D'Agostino, RN, APRN, BC
• Francis A D'Urso, M.D
• Christina Daletto
• Megan Eileen Haight Daley
• Stephen Michael Daly, MD
• Anthony Peter Danas, D.D.S.
• Maziyar Daneshvar, DO

• Critical Care Pediatric Nurse Practitioner in Middletown, NY
• Providers in Middletown, NY by specialty
• Critical Care Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.