NPIMap

Individual provider Active NPI

Marie-Jeanne Desravines, M.D.

  • Family Medicine Physician
  • Fulton, NY
National Provider Identifier
1285741199
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
221962 Issued in NY
Practice address
522 S 4TH St
Suite 500
Fulton, NY 13069-2946
Phone
(315) 598-4740
Fax
(315) 598-4719
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 221962 NY Primary

Addresses

Primary practice location

522 S 4TH St
Suite 500
Fulton, NY 13069-2946

Mailing address

239 Oneida St
Fulton, NY 13069-1228
Phone (315) 598-4715

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060228000246 NY Practitioner - Family Practice 5496761538 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of Ny Upstate Medical University, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Oswego County Health Services, Inc. 37 clinicians

Practice addresses (Care Compare)

510 S 4TH St
Suite 600
Fulton, NY 13069-2952
Phone (315) 598-4790

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Liverpool, NY, CCN 337255
  • Oswego Health Home Care, LLC Home health agency, Fulton, NY, CCN 337284
  • Oswego Hospital Hospital, Oswego, NY, CCN 330218

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Oswego County Health Services, Inc. CurrentSince Jan 1, 2013 Accepting new patients
The Maples Adult Living Community Past Accepting new patients

Locations

510 S 4th St
Ste 600
Fulton, NY 13069
Phone (315) 598-4790

10 George St
Oswego, NY 13126
Phone (315) 342-0880

61 Delano St
Pulaski, NY 13142
Phone (315) 298-4274

Interoperability endpoints

  • Direct secure messaging: marie.desravines@nochsi.directbygreenway.com

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285741199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 ONEIDA ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691228",
            "telephone_number": "315-598-4715",
            "fax_number": "315-598-4733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 S 4TH ST",
            "address_2": "SUITE 500",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130692946",
            "telephone_number": "315-598-4740",
            "fax_number": "315-598-4719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESRAVINES",
        "first_name": "MARIE-JEANNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "221962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, NY

Sources for this page

Verify at the official NPI Registry.