Samir Derisavifard, MD

Primary specialty

Urogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianTaxonomy code 2088F0040X

License

282292-01 Issued in NY

Practice address

50 Eastdale Ave N
Poughkeepsie, NY 12603-1694

Phone

(845) 437-5000

NPI assigned

Apr 18, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Urology

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

North Shore Lij Medical Group at North Nassau, PCGroup PAC ID 7618154550, 36 clinicians

Premier Medical Group of the Hudson Valley PCGroup PAC ID 3072575109, 134 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Long Island Jewish Medical Center Hospital, New Hyde Park, NY, CCN 330195
• Northwell Hospital Glen Cove Hospital, Glen Cove, NY, CCN 330181

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

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

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.

• North Shore Lij Medical Group at North Nassau, PC

  • Cardiovascular Disease Physician
  • Glen Cove, NY
  • NPI 1700175270
  Medicare reassignment Care Compare group NPD
• Premier Medical Group of the Hudson Valley P.C.

  • Urology Physician
  • Poughkeepsie, NY
  • NPI 1255437166
  Medicare reassignment Care Compare group
• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment NPD
• North Shore - Lij Medical PC

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD
• Long Island Jewish Medical Center

  • General Acute Care Hospital
  • New Hyde Park, NY
  • NPI 1285641514
  NPD (past)

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

• Glen Cove Hospital

  • General Acute Care Hospital
  • Glen Cove, NY
  • NPI 1295743060
  Care Compare affiliation
• Long Island Jewish Medical Center

  • General Acute Care Hospital
  • New Hyde Park, NY
  • NPI 1285641514
  Care Compare affiliation

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

{
    "created_epoch": "1366243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1477997690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 NORTH RD STE 304",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126011173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 EASTDALE AVE N",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126031694",
            "telephone_number": "845-437-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERISAVIFARD",
        "first_name": "SAMIR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-18",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "NY",
            "license": "282292-01",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "282292-01",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Anthony Dentico, M.D.
• Detra Denton, LPN
• Richard Gary Depass, PHD
• Nicole Der Boghossian
• Renee Deresh, DPT
• Joanna Kerene Derisse
• Dermatology & Allergy Associates of the Hudson Valley, LLP
• Alma Derosa, CASAC
• Jeanne Marie Desanna, LCSW-R
• Samantha Desantis

• Urology Physician in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Urology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; 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.