Timothy Dezastro, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

1781211 Issued in NY

Practice address

222 Genesee St
Buffalo, NY 14203

Phone

(716) 855-2866

Fax

(716) 855-2860

NPI assigned

May 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Trillium Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Rochester, NY
  • NPI 1861496358
  Medicare reassignment NPD
• Trillium Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Rochester, NY
  • NPI 1265098941
  NPD
• Ultramobile Imaging Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Rochester, NY
  • NPI 1770600876
  NPD
• BTX Koi Inc

  dba Biotech X-Ray

  • Physiological Laboratory
  • Cincinnati, OH
  • NPI 1245696731
  NPD
• Quality Medical Imaging of Arizona, Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Phoenix, AZ
  • NPI 1417124637
  NPD
• Quality Medical Imaging of California, Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Aliso Viejo, CA
  • NPI 1467610212
  NPD
• Quality Medical Imaging of Nevada LLC

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Las Vegas, NV
  • NPI 1295992998
  NPD
• Quality Medical Imaging of Utah, Inc.

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Washington, UT
  • NPI 1407023625
  NPD
• Quality Medical Imaging of Washington Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Kent, WA
  • NPI 1336404177
  NPD

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1598723017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8000",
            "address_2": "DEPT 836",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 GENESEE ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14203",
            "telephone_number": "716-855-2866",
            "fax_number": "716-855-2860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEZASTRO",
        "first_name": "TIMOTHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "1781211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "CRDRA178121",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00003640",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF WESTERN NY",
            "identifier": "000525009025",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "145797FF",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF WESTERN NY",
            "identifier": "000525009022",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "RB6952",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF WESTERN NY",
            "identifier": "000525009016",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01607547",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300138602",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "5609880",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth G Dewey, MD
• Danielle Dexheimer
• Dexter Prescription Center Inc
• Elisabeth U Dexter, MD
• Derek Paul Deyoung, RN
• Rajveer Dhaliwall
• Arpan Dharia, MD
• Ananda Coomaraswamy Dharshan, MD
• Aliza Dharssi, M.D.
• Jasmine Dhillon

• Diagnostic Radiology Physician in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.