NPIMap

Individual provider Active NPI

Desarom Teso, M.D.

  • Surgery Physician
  • Boston, MA
National Provider Identifier
1558579565
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
231053 Issued in MA
Practice address
750 Washington St
Tufts-Nemc #437
Boston, MA 02111-1526
Phone
(617) 636-5891
NPI assigned
May 21, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 231053 MA Primary

Addresses

Primary practice location

750 Washington St
Tufts-Nemc #437
Boston, MA 02111-1526

Mailing address

149 Bunker Hill Ave
Apt 1
Waterbury, CT 06708-2223
Phone (203) 768-5106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220530000165 CO Practitioner - Vascular Surgery 4880773951 Reassigns benefits to 3 organizations
I20240130003123 AZ Practitioner - Vascular Surgery 4880773951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Hawaii John a. Burns School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

12905 W 40TH Ave
Wheat Ridge, CO 80401-2793

2635 N 7TH St
Grand Junction, CO 81501-8209

300 Exempla Cir
Lafayette, CO 80026-3396

300 Exempla Cir
310 Imh Heart and Vascular Institute Lafayatt
Lafayette, CO 80026-3394
Phone (303) 272-0500

340 Exempla Cir
300 Lafayette Clinic Neurosurgery
Lafayette, CO 80026-3384
Phone (303) 673-1390

8350 Colorado Blvd
Unit 160
Firestone, CO 80504-6803
Phone (303) 673-1370

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
231053MAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Grand Junction, LLC CurrentSince May 2, 2022 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince May 2, 2022 Accepting new patients
Yuma Regional Medical Center CurrentSince Feb 1, 2024 Accepting new patients
Yuma Regional Medical Center CurrentSince Feb 1, 2024 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jan 4, 2026 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jan 4, 2026 Accepting new patients
Intermountain Medical Group Grand Junction, LLC Current Accepting new patients

Locations

2270 S Ridgeview Dr
Ste 201
Yuma, AZ 85364
Phone (928) 344-5055

2400 S Avenue A
Yuma, AZ 85364
Phone (928) 336-7100

500 Eldorado Blvd
Ste 4300
Broomfield, CO 80021

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

2643 Patterson Rd
Ste 605
Grand Junction, CO 81506
Phone (970) 244-2482

340 Exempla Cir
Ste 300
Lafayette, CO 80026
Phone (303) 673-1390

Interoperability endpoints

  • Direct secure messaging: dteso3028@direct.peacehealth.org

Organizations & group practices 9

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 6

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": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558579565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 BUNKER HILL AVE",
            "address_2": "APT 1",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082223",
            "telephone_number": "203-768-5106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 WASHINGTON ST",
            "address_2": "TUFTS-NEMC #437",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111526",
            "telephone_number": "617-636-5891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESO",
        "first_name": "DESAROM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "231053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.