Jeremiah Jordan Decasteele

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

63 Ohio Ave
Groton, CT 06340-6106

Phone

(631) 992-0705

NPI assigned

Jan 3, 2024

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1704240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1508636366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 OHIO AVE",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406106",
            "telephone_number": "631-992-0705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 OHIO AVE",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406106",
            "telephone_number": "631-992-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECASTEELE",
        "first_name": "JEREMIAH",
        "middle_name": "JORDAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-03",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Michael Davenport, AUD
• Diane Meg Davidson, MD
• Peter Arnold Davis, PA-C
• Steven De Castro
• Arthur Fred Dean, DMD
• Lisa Degraff, LMFT
• Sarah E Del Grosso, LPC
• Taylor Del Viscovo, PA
• Jose Luis Delgado III
• Ellen Catherine Denigris, MD

• All providers in Groton, CT
• Independent Duty Corpsman in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.