Susan Distasio, D.O.

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

271109 Issued in NY

Practice address

3713 E Tremont Ave
Bronx, NY 10465-2054

Phone

(718) 792-4878

NPI assigned

May 8, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Physical Medicine and RehabilitationAlso: Pain Management

Education

New York College of Osteo Medicine of New York Institute of Technology, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Multi-Specialty Pain Management PCGroup PAC ID 1254220650, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Multi-Specialty Pain Management, PC

  • Pain Medicine (Anesthesiology) Physician
  • Bronx, NY
  • NPI 1891820726
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1241740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1700010410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8717 17TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112144546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3713 E TREMONT AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104652054",
            "telephone_number": "718-792-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTASIO",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-08",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NY",
            "license": "271109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jazmin Disla
• Karina Ybel Disla, MSW
• Paola Disla, LMHC
• Sharon A Distant Johnson, DMD
• Marina Distant, PHARM. D
• Distinguished Diagnostic Imaging P.C.
• Shirley Disu, PSYD, NC-PSYA
• Giana Ditonto
• Katherine A Ditren
• Laura J Ditusa, AU.D.

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; 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.
• 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.