Samuel Dean Detweiler, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

157873 Issued in 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

Last updated

Sep 21, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: General Practice

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Mary's HealthcareGroup PAC ID 7618960709, 114 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marquis Certified Home Care, LLC Home health agency, Albany, NY, CCN 337418
• St Marys Healthcare Hospital, Amsterdam, NY, CCN 330047
• Nathan Littauer Hospital Hospital, Gloversville, NY, CCN 330276

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St Marys Healthcare

  • General Acute Care Hospital
  • Amsterdam, NY
  • NPI 1518926401
  Medicare reassignment Care Compare group NPD
• St. Mary's Healthcare

  dba Opioid Treatment Program

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Amsterdam, NY
  • NPI 1700636347
  NPD
• Amsterdam Memorial Hospital

  • Skilled Nursing Facility
  • Amsterdam, NY
  • NPI 1578624599
  NPD (past)
• St. Mary's Healthcare

  • General Acute Care Hospital
  • Amsterdam, NY
  • NPI 1811977796
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Marquis Certified Home Care, LLC

  • Home Health Agency
  • Albany, NY
  • NPI 1316522964
  Care Compare affiliation
• Marquis Certified Home Care, LLC

  • Home Health Agency
  • Albany, NY
  • NPI 1467074898
  Care Compare affiliation
• Nathan Littauer Hospital & Nursing Home

  • General Acute Care Hospital
  • Gloversville, NY
  • NPI 1538296207
  Care Compare affiliation
• Nathan Littauer Hospital Association

  • Pharmacy
  • Gloversville, NY
  • NPI 1285706655

  Hospital

  Care Compare affiliation
• Nathan Littauer Hospital Association

  dba Nathan Littauer Hospital & Nursing Home

  • Rural Acute Care Hospital
  • Gloversville, NY
  • NPI 1336145168
  Care Compare affiliation
• Nathan Littauer Hospital Association

  dba Nathan Littauer Primary/Specialty Care Centers

  • Clinic/Center
  • Gloversville, NY
  • NPI 1770671448

  Hospital

  Care Compare affiliation
• St. Mary's Healthcare

  • General Acute Care Hospital
  • Amsterdam, NY
  • NPI 1811977796
  Care Compare affiliation

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285027200000",
    "number": "1437299237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT.",
            "address_2": "ST. MARY'S HOSPITAL AT AMSTERDAM",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "12010",
            "telephone_number": "518-841-7430",
            "fax_number": "518-841-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 BRIDGE ST",
            "address_2": "ST. MARY'S HOSPITAL, NORTHVILLE FAMILY HEALTH CENTER",
            "city": "NORTHVILLE",
            "state": "NY",
            "postal_code": "12134",
            "telephone_number": "518-863-4200",
            "fax_number": "518-863-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETWEILER",
        "first_name": "SAMUEL",
        "middle_name": "DEAN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2010-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "157873",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "157873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS PROVIDER NUMBER",
            "identifier": "000419006006",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10000485",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "77787",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "040426006943",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adirondack Physical Therapy
• Kasey Morgan Aiken, PHARM.D.
• Board of Education Dist 1
• Ashley R Czyzewski, PHARMD
• Madeline Downing
• Ashley Dumblewski
• Annette Elise Fordyce, RN
• Erin Elizabeth Gurdineer, PSY.D.
• Hanna A Halloran, PT

• Family Medicine Physician in Northville, NY
• Providers in Northville, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.