Douglas Craig Distefano, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

127858 Issued in NY

Practice address

1190 5TH Ave
New York, NY 10029-6503

Phone

(212) 427-1540

Fax

(212) 410-7196

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Cardiovascular Disease (Cardiology)

Education

New York University School of Medicine, 1974

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Icahn School of Medicine at Mount SinaiGroup PAC ID 2264691070, 2,809 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mount Sinai Hospital Hospital, New York, NY, CCN 330024

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• Icahn School of Medicine at Mount Sinai

  • Cardiovascular Disease Physician
  • New York, NY
  • NPI 1487912416
  Medicare reassignment Care Compare group NPD
• Icahn School of Medicine at Mount Sinai

  • Eyewear Supplier
  • New York, NY
  • NPI 1760227466
  NPD
• Icahn School of Medicine at Mount Sinai

  • Obstetrics & Gynecology Physician
  • New York, NY
  • NPI 1124392212
  NPD (past)
• Mount Sinai Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1932103413
  NPD (past)
• Trustees of Columbia University in the City of New York

  • Internal Medicine Physician
  • New York, NY
  • NPI 1437176047
  NPD (past)
• Trustees of Columbia University in the City of New York

  • Surgery Physician
  • New York, NY
  • NPI 1508266347
  NPD (past)

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

• Mount Sinai Hospital

  • Clinical Medical Laboratory
  • New York, NY
  • NPI 1033206362

  Hospital

  Care Compare affiliation
• Mount Sinai Hospital

  • General Acute Care Hospital
  • Long Island City, NY
  • NPI 1245248939
  Care Compare affiliation
• Mount Sinai Hospital

  • Rehabilitation Hospital
  • New York, NY
  • NPI 1669440327
  Care Compare affiliation
• Mount Sinai Hospital

  • General Acute Care Hospital
  • New York, NY
  • NPI 1932103413
  Care Compare affiliation
• Mount Sinai Hospital Pharmacy

  • General Acute Care Hospital
  • New York, NY
  • NPI 1225295512
  Care Compare affiliation
• Mount Sinai Hospital-Ambulance

  • Ambulance
  • New York, NY
  • NPI 1568601342

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1487795225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 PARK AVE APT 1L",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101281307",
            "telephone_number": "212-427-6101",
            "fax_number": "212-427-6128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 5TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296503",
            "telephone_number": "212-427-1540",
            "fax_number": "212-410-7196"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Gustave L Levy Pl",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296504",
            "country_code": "US",
            "telephone_number": "212-427-1540",
            "fax_number": "212-410-7196",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1185 Park Ave Apt 1L",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "101281307",
            "country_code": "US",
            "telephone_number": "212-427-6101",
            "fax_number": "212-427-6128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DISTEFANO",
        "first_name": "DOUGLAS",
        "middle_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "127858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00349606",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ayelet Dissen, PA
• Elaine G Distasi, MSW, LCSW
• John Distasio, M.A., ED., S.A.S.
• Alberto Giuseppe Distefano, M.D.
• Alessandra Teresa Distefano, PA-C
• Janet A Distefano, R.PH.
• Michele Distefano, MS, CCC/A
• Betsy Danielle Distelburger, PA-C
• Barbara Distler, PSY.D.
• Emma Jun Distler

• Cardiovascular Disease Physician in New York, NY
• Providers in New York, NY by specialty
• Cardiovascular Disease Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; 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.