Active NPI
Michael A Depetrillo Jr., M.D.
- Anesthesiology Physician
- Schenectady, NY
National Provider Identifier
1497755441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 127532-1
- Practice address
- 1201 Nott St
Suite 106
Schenectady, NY 12308-2589 - Phone
- (518) 374-3123
- Fax
- (518) 374-9711
- NPI assigned
- Jul 29, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 127532-1 | NY | Primary |
Addresses
Primary practice location
1201 Nott St
Suite 106
Schenectady, NY 12308-2589
Mailing address
1201 Nott St
Suite 106
Schenectady, NY 12308-2589
Phone (518) 374-3123
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05104 | Other | MVP | |
| 040426006657 | Other | FIDELIS | |
| MD000A2810 | Other | EMPIRE BLUE CROSS | |
| 000405064003 | Other | BLUE SHIELD NENY | |
| 127532-1 | Other | TRICARE NORTH REGION | |
| 000405064002 | Other | BLUE SHIELD NENY | |
| 00392847 | Medicaid | NY | |
| 00A28 | Other | EMPIRE BLUE CROSS | |
| 110160500 | Other | US DEPT OF LABOR | |
| 9599341 | Other | GHI | |
| CAN1275320 | Other | NO FAULT | |
| 10000479 | Other | CDPHP | |
| CAN1275320 | Other | WORKERS COMP | |
| MD000A2820 | Other | EMPIRE BLUE CROSS | |
| 000000097790 | Other | GHI HMO | |
| 33570P | Other | FIDELIS MEDICARE | |
| D01979 | Other | AMERICAN PROGRESSIVE TODA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 127532-1 | NY | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289347200000",
"number": "1497755441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 NOTT ST",
"address_2": "SUITE 106",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123082589",
"telephone_number": "518-374-3123",
"fax_number": "518-374-9711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 NOTT ST",
"address_2": "SUITE 106",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123082589",
"telephone_number": "518-374-3123",
"fax_number": "518-374-9711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEPETRILLO",
"first_name": "MICHAEL",
"middle_name": "A",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-29",
"last_updated": "2010-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NY",
"license": "127532-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "05104",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS",
"identifier": "040426006657",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BLUE CROSS",
"identifier": "MD000A2810",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD NENY",
"identifier": "000405064003",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE NORTH REGION",
"identifier": "127532-1",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD NENY",
"identifier": "000405064002",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00392847",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BLUE CROSS",
"identifier": "00A28",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPT OF LABOR",
"identifier": "110160500",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "9599341",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NO FAULT",
"identifier": "CAN1275320",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDPHP",
"identifier": "10000479",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKERS COMP",
"identifier": "CAN1275320",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BLUE CROSS",
"identifier": "MD000A2820",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI HMO",
"identifier": "000000097790",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS MEDICARE",
"identifier": "33570P",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN PROGRESSIVE TODA",
"identifier": "D01979",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Schenectady, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.