Individual provider Active NPI

Stephan Nickolas Deturris

  • Certified Registered Nurse Anesthetist
  • Stony Brook, NY
National Provider Identifier
1538059464
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
734070-01 Issued in NY
Practice address
101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone
(631) 638-3700
NPI assigned
Jul 3, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 734070-01 NY Primary

Addresses

Primary practice location

101 Nicolls Rd
Stony Brook, NY 11794-0001

Mailing address

PO Box 26
Commack, NY 11725-0026
Phone (631) 745-9998

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251111002004 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 2466943105 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

530 1St Ave
New York, NY 10016-6402

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-6037

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
734070-01NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Nov 1, 2025 Accepting new patients
New York University CurrentSince Nov 1, 2025 Accepting new patients
New York University Current Accepting new patients

Locations

530 1st Ave
New York, NY 10016
Phone (212) 263-7216

9785 Queens Blvd
Rego Park, NY 11374
Phone (631) 360-0266

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1751500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1538059464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117250026",
            "telephone_number": "631-745-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-638-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETURRIS",
        "first_name": "STEPHAN",
        "middle_name": "NICKOLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-03",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "734070-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2025; 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.