Tara Deitrick

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

9330 Issued in NY

Practice address

259 1St St
Mineola, NY 11501-3957

Phone

(516) 741-0570

Fax

(516) 741-8276

NPI assigned

Sep 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Endoscopy Center of Long Island LLCGroup PAC ID 2668370123, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Networks

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

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.

• Endoscopy Center of Long Island LLC

  • Endoscopy Clinic/Center
  • Garden City, NY
  • NPI 1770718009
  Medicare reassignment Care Compare group
• North Shore - Lij Anesthesiology, PC

  • Anesthesiology Physician
  • Chappaqua, NY
  • NPI 1417401266
  Medicare reassignment
• Nassau Anesthesia Associates PC

  • Anesthesiology Physician
  • Mineola, NY
  • NPI 1578961645
  NPD (past)

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511913600000",
    "number": "1497855704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 KENWOOD RD",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115303034",
            "telephone_number": "516-248-1420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-741-0570",
            "fax_number": "516-741-8276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEITRICK",
        "first_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2017-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "9330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Paul Deacetis
• Magdalena Quimpo Deblois, ANP
• Don Decrosta, D.O.
• Inge Decrosta
• Mary B Deegan Haff, D.O.
• Charlene Del Rosario
• Theresa M Del Vecchio, ANP-C
• Maryellen Delcarpine, ANP
• Joshua Deleon, MD
• Ralph K Della Ratta, MD

• Certified Registered Nurse Anesthetist in Mineola, NY
• Providers in Mineola, NY by specialty
• Certified Registered Nurse Anesthetist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.