Josephine Detar, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

1867691 Issued in NY

Practice address

1927 Woods Edge Dr
Millport, NY 14864-9730

Phone

(800) 394-4445

NPI assigned

May 16, 2006

Last updated

Jun 14, 2008By the provider in NPPES

Sex

Female

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 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Chemung Medical Services PC

  dba Arnot Medical Services

  • Internal Medicine Physician
  • Elmira, NY
  • NPI 1356378889
  NPD (past)
• Fort Edward Rescue Squad Inc

  • Ambulance
  • Fort Edward, NY
  • NPI 1427031319
  NPD (past)

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213401600000",
    "number": "1306897970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1927 WOODS EDGE DR",
            "city": "MILLPORT",
            "state": "NY",
            "postal_code": "148649730",
            "telephone_number": "800-394-4445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1927 WOODS EDGE DR",
            "city": "MILLPORT",
            "state": "NY",
            "postal_code": "148649730",
            "telephone_number": "800-394-4445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETAR",
        "first_name": "JOSEPHINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2008-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "1867691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "610421800",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01390312",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018396300001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "008130315",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "050084782",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shanatha Crandall, LPN
• Tiffaney Aleyse Perry
• Mary Jo Mallory Rhodes, LPN

• Anesthesiology Physician in Millport, NY
• Providers in Millport, NY by specialty
• Anesthesiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.