NPIMap

Organization Active NPI

Diversified Services for Occupational Therapy, Physical Ther

Doing business as Diversified Services, LLC

  • Audiologist
  • Kenmore, NY
National Provider Identifier
1447283882
Registry record updated May 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
001149 Issued in NY
Legal business name
DIVERSIFIED SERVICES FOR OCCUPATIONAL THERAPY, PHYSICAL THER
Doing business as
Diversified Services, LLC
Practice address
2900 Delaware Ave
Kenmore, NY 14217-2309
Phone
(716) 871-9883
Fax
(716) 871-9887
NPI assigned
Jul 9, 2006
Last updated
May 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2020

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

Authorized official

Name
Dr. Salvatore Gruttadauria, AU.D.NPI 1336178821
Title
President-Ceo
Phone
(716) 871-9883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Oxygen Equipment & Supplies (DME) 332BX2000X
Hearing Aid Equipment 332S00000X
Audiologist 231H00000X 001149 NY Primary
Speech-Language Pathologist 235Z00000X 000846 NY

Addresses

Primary practice location

2900 Delaware Ave
Kenmore, NY 14217-2309

Mailing address

2900 Delaware Ave
Kenmore, NY 14217-2309
Phone (716) 871-9883

Other identifiers 6

IdentifierTypeStateIssuer
02690884MedicaidNY
02690875MedicaidNY
02700365MedicaidNY
01806404MedicaidNY
02667421MedicaidNY
02671290MedicaidNY

Other names 1

  • Diversified Services, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050805000553 NY Part B Supplier - Clinic/Group Practice 0143204917 Receives reassigned benefits from 33 practitioners
1 other NPI on this enrollment
Practice locations: Lockport, NY; Williamsville, NY; Warsaw, NY; Orchard Park, NY; Niagara Falls, NY; Kenmore, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Children's Rehab Services of Wny4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2407 N Main St
Ste 3
Warsaw, NY 14569

Practitioners & affiliated clinicians

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588550400000",
    "number": "1447283882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 DELAWARE AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172309",
            "telephone_number": "716-871-9883",
            "fax_number": "716-871-9887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 DELAWARE AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172309",
            "telephone_number": "716-871-9883",
            "fax_number": "716-871-9887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED SERVICES FOR OCCUPATIONAL THERAPY, PHYSICAL THER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A",
        "authorized_official_last_name": "GRUTTADAURIA",
        "authorized_official_first_name": "SALVATORE",
        "authorized_official_title_or_position": "PRESIDENT-CEO",
        "authorized_official_telephone_number": "716-871-9883",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "AU.D."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332S00000X",
            "taxonomy_group": "",
            "desc": "Hearing Aid Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NY",
            "license": "001149",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "000846",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02690884",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02690875",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02700365",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01806404",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02667421",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02671290",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversified Services, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenmore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.