Individual provider Active NPI

Thomas A Derosa, DPT

  • Physical Therapist
  • Riverhead, NY
National Provider Identifier
1396005518
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
1149 Old Country Rd Ste A2
Riverhead, NY 11901-2059
Phone
(631) 284-9258
Fax
(631) 284-9260
NPI assigned
May 22, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1149 Old Country Rd Ste A2
Riverhead, NY 11901-2059

Mailing address

1149 Old Country Rd Ste A2
Riverhead, NY 11901-2059
Phone (631) 284-9258

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121211000463 NY Practitioner - Physical Therapist in Private Practice 5092967497 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson Sports and Physical Therapy PCGroup PAC ID 6103963558, 4 clinicians
New York UniversityGroup PAC ID 1355232422, shared by 41 NPIs, 5,925 clinicians

Practice addresses (Care Compare)

460 County Rd
111 Unit 15
Manorville, NY 11949-3376
Phone (631) 909-8712

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

5958 Ny
25A
Wading River, NY 11792-0521
Phone (631) 929-8200

9785 Queens Blvd
Rego Park, NY 11374-3319
Phone (718) 261-9100

Merit-based Incentive Payment System (MIPS)

Final score
93.83 of 100Reported as group
Quality
100
Improvement activities
40
Cost
79.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Sports & Physical Therapy, PC Physical Therapist CurrentSince Mar 2, 2015 Accepting new patients

Locations

460 County Road 111
Unit 15
Manorville, NY 11949
Phone (631) 909-8712

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1396005518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 OLD COUNTRY RD STE A2",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012059",
            "telephone_number": "631-284-9258",
            "fax_number": "631-284-9260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 OLD COUNTRY RD STE A2",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012059",
            "telephone_number": "631-284-9258",
            "fax_number": "631-284-9260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSA",
        "first_name": "THOMAS",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-22",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.