Tim Charles Desano

Primary specialty

ContractorTaxonomy code 171W00000X

Practice address

30808 Island Dr
Gibraltar, MI 48173-9547

Phone

(734) 915-1270

Fax

(734) 250-7377

NPI assigned

Jun 19, 2009

Last updated

Nov 13, 2009By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

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.

• Alpha Physicians, PLLC

  • Home Health Agency
  • Gibraltar, MI
  • NPI 1023290780
  Authorized official Same address or phone
• Physicians Plus LLC

  • Home Health Agency
  • Gibraltar, MI
  • NPI 1811224751

  Contractor

  NPD (past) Authorized official

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

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258070400000",
    "number": "1356578108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30808 ISLAND DR",
            "city": "GIBRALTAR",
            "state": "MI",
            "postal_code": "481739547",
            "telephone_number": "734-915-1270",
            "fax_number": "734-250-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30808 ISLAND DR",
            "city": "GIBRALTAR",
            "state": "MI",
            "postal_code": "481739547",
            "telephone_number": "734-915-1270",
            "fax_number": "734-250-7377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESANO",
        "first_name": "TIM",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-19",
        "last_updated": "2009-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Meade Bonham, PHARM D
• Douglas Booker, RPH
• William Cain
• City of Gibraltar (Gibraltar PSD)
• Conscious Mind Psychiatry of Michigan (Conscious Mind Psychiatry)
• Gibraltar Pharmacy Inc (Gibraltar Sav-Mor Pharmacy #16)
• Donovan Matthew Haddix, RPH
• Warren Michael Horbal, D.D.S.
• Jennifer Lyn Johnson, MS LLP
• Elizabeth Sarah Jordan

• Contractor in Gibraltar, MI
• Providers in Gibraltar, MI by specialty
• Contractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.