Samuel Dean Detweiler, MD
Individual provider Active NPI Family Medicine Physician · Northville, NY
NPI 1437299237 · NPPES record last updated Sep 21, 2010
Key facts
- NPI
- 1437299237
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 157873 (NY)
- Practice address
- 331 Bridge St
St. Mary'S Hospital, Northville Family Health Center
Northville, NY 12134 - Phone
- (518) 863-4200
- Fax
- (518) 863-4787
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 9
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St. Mary'S Healthcare
Practice addresses (Care Compare)
84 E State St
Gloversville, NY 12078-1202
Phone (518) 773-8894
Hospital & facility affiliations
- Marquis Certified Home Care, LLC
- St Marys Healthcare
- Nathan Littauer Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal or shaving of skin growth | 1-10 |
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
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090804000421 | NY | Practitioner - Family Practice |
6103979489 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Marys Healthcare | Current |
Accepting new patients | |
| St. Mary'S Healthcare | Current |
Accepting new patients | |
| Amsterdam Memorial Hospital | Past | Accepting new patients | |
| St. Mary'S Healthcare | Past | Accepting new patients |
Locations
4988 State Highway 30
Amsterdam, NY 12010
Phone (518) 842-3100
380 Guy Park Ave
Amsterdam, NY 12010
Phone (518) 841-7415
427 Guy Park Ave
Amsterdam, NY 12010
Phone (518) 442-1404
84 E State St
Gloversville, NY 12078
Phone (518) 332-4336
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 157873 | NY | |
| Family Medicine Physician | 207Q00000X | 157873 | NY | Yes |
Addresses
Primary practice location
331 Bridge St
St. Mary'S Hospital, Northville Family Health Center
Northville, NY 12134
Mailing address
427 Guy Park Ave - Primary & Specialty Care Dept.
St. Mary'S Hospital at Amsterdam
Amsterdam, NY 12010
Phone (518) 841-7430
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000419006006 | Other | NY | BS PROVIDER NUMBER |
| 77787 | Other | NY | MVP |
| 040426006943 | Other | NY | FIDELIS |
| 10000485 | Other | NY | CDPHP |
Other providers in Northville, NY
- Adirondack Physical Therapy
- Kasey Morgan Aiken
- Board of Education Dist 1
- Ashley R Czyzewski
- Madeline Downing
- Ashley Dumblewski
- Annette Elise Fordyce
- Erin Elizabeth Gurdineer
- Hanna A Halloran
All providers in Northville, 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 Sep 21, 2010. 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.
- 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.