NPIMap

Individual provider Active NPI

Joseph J Derose, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Bronx, NY
National Provider Identifier
1386629921
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
2028061 Issued in NY
Practice address
MMC. Cardiothoracic Surgery 1575 Blondell Ave.
Suite 125
Bronx, NY 10461
Phone
(718) 920-4799
Fax
(718) 653-2237
NPI assigned
Dec 7, 2005
Last updated
Nov 2, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2028061 NY
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 2028061 NY Primary

Addresses

Primary practice location

MMC. Cardiothoracic Surgery 1575 Blondell Ave.
Suite 125
Bronx, NY 10461

Mailing address

MMC. Cardiothoracic Surgery 3400 Bainbridge Ave.
5TH Floor
Bronx, NY 10467-2490
Phone (718) 920-4799

Other identifiers 1

IdentifierTypeStateIssuer
02149333MedicaidNY

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
I20050920001277 NY Practitioner - Cardiac Surgery 9537193438 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Surgery
Education
Columbia University College of Physicians and Surgeons, 1993
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)22
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2028061NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Surgery CurrentSince Oct 13, 2006 Accepting new patients
Montefiore Medical Center CurrentSince Oct 13, 2006 Accepting new patients
Montefiore Medical Center Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

1575 Blondell Ave
Ste 125
Bronx, NY 10461
Phone (718) 405-8238

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: jderose@montefioredirect.com

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1386629921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MMC. CARDIOTHORACIC SURGERY 3400 BAINBRIDGE AVE.",
            "address_2": "5TH FLOOR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672490",
            "telephone_number": "718-920-4799",
            "fax_number": "718-653-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MMC. CARDIOTHORACIC SURGERY 1575 BLONDELL AVE.",
            "address_2": "SUITE 125",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10461",
            "telephone_number": "718-920-4799",
            "fax_number": "718-653-2237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSE",
        "first_name": "JOSEPH",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "2028061",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NY",
            "license": "2028061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02149333",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.