Individual provider Active NPI

Dana Marie Tedesco

  • Physician Assistant
  • Rockville Centre, NY
National Provider Identifier
1689239758
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1000 N Village Ave
Rockville Centre, NY 11570-1000
Phone
(516) 705-2525
NPI assigned
May 4, 2019
Last updated
Dec 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1000 N Village Ave
Rockville Centre, NY 11570-1000

Mailing address

1308 Mill Rd
Ronkonkoma, NY 11779-1402
Phone (516) 697-4400

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191120003211 NY Practitioner - Physician Assistant 9638501158 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Samaritan Medical Services PCGroup PAC ID 7012016009, 341 clinicians

Practice addresses (Care Compare)

1000 Montauk Hwy
West Islip, NY 11795-4927
Phone (516) 705-2689

1000 N Village Ave
Rockville Center, NY 11570-1000
Phone (516) 705-3656

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
John T Mather Memorial Hospital Current Accepting new patients
John T. Mather Memorial Hospital Current Accepting new patients
John T Mather Memorial Hospital CurrentSince Oct 28, 2023 Accepting new patients
John T. Mather Memorial Hospital CurrentSince Oct 28, 2023 Accepting new patients
John T. Mather Memorial Hospital Current Accepting new patients
John T Mather Memorial Hospital Current Accepting new patients

Locations

100 Highlands Blvd
#9
Port Jefferson, NY 11777
Phone (631) 686-7809

75 N Country Rd
Prt Jefferson, NY 11777
Phone (631) 463-1320

Networks

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

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1556928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1689239758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 MILL RD",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117791402",
            "telephone_number": "516-697-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N VILLAGE AVE",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115701000",
            "telephone_number": "516-705-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDESCO",
        "first_name": "DANA MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-04",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

Verify at the official NPI Registry.