Kimberly M Desantis, MD
Individual provider Active NPI Family Medicine Physician · Endwell, NY
NPI 1376578724 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376578724
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 211449 (NY)
- Practice address
- 415 Hooper Rd
Endwell Family Physicians LLP
Endwell, NY 13760-3646 - Phone
- (607) 754-3863
- Fax
- (607) 754-5697
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 5
Owned or controlled facilities with NPI records 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- State University of New York at Buffalo School of Medicine, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Endwell Family Physicians LLP
Practice addresses (Care Compare)
415 Hooper Rd
Endwell, NY 13760-3646
Phone (607) 754-3863
Hospital & facility affiliations
- Twin Tier Home Health, Inc
- United Health Services Hospitals, Inc
- Our Lady of Lourdes Memorial Hospital, Inc
- Chenango Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 83.22 of 100
- Quality
- 78.62
- Promoting interoperability
- 96
- Improvement activities
- 40
- Cost
- 68.76
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Wilson Hospital and Binghamton General Hospital |
Hospital | Corporate Director | May 25, 2022 |
| United Health Services Hospitals, Inc. |
Hospital | Corporate Director | May 25, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100112000252 | NY | Practitioner - Family Practice | 9739163908 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 211449 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Endwell Family Physicians LLP | Family Medicine | Current | Accepting new patients |
| Endwell Family Physicians LLP | Family Medicine | Current |
Accepting new patients |
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Lakeshore Primary Care Associates LLP | Family Medicine | Past | Accepting new patients |
| Highgate Medical Group | Family Medicine | Past |
Accepting new patients |
Locations
415 Hooper Rd
Endwell, NY 13760
Phone (607) 754-3863
Interoperability endpoints
- kdesantis@efp.medentdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 211449 | NY | Yes |
Addresses
Primary practice location
415 Hooper Rd
Endwell Family Physicians LLP
Endwell, NY 13760-3646
Mailing address
415 Hooper Rd
Endwell, NY 13760-3646
Phone (607) 754-3863
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10074276 | Other | CDPHP | |
| 7455028 | Other | AETNA HMO | |
| 01943728 | Medicaid | NY | |
| 5997006 | Other | GHI | |
| 699965 | Other | MVP | |
| 71561388 | Other | CHAMPUS | |
| 153925 | Other | EMPIRE BS | |
| 153925 | Other | EXCELLUS | |
| 699965 | Other | MVP SELECT | |
| 153925 | Other | BS CNY | |
| 153925 | Other | HMO BLUE | |
| 7455028 | Other | AETNA | |
| 153925 | Other | BLUEPOINT | |
| 76410 | Other | GHI HMO |
Other names
- Kimberly Ellen Metz
Other providers in Endwell, NY
- Leon Edward Cosler
- CVS Albany LLC
- Darrell Hunink Physical Therapy P.C.
- Matthew Demtrak
- Miranda Desanctis
- Janet M Dimaria
- Anthony Donatelli III
- Donson Transportation Services, Inc
- Eckerd Corporation
- Victor A Elinoff
All providers in Endwell, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.