Active NPI
Thomas Gerald Disessa, MD
- Pediatric Cardiology Physician
- Lexington, KY
National Provider Identifier
1780604462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 38090
- Practice address
- 3945 Peppertree Dr
Lexington, KY 40513-1398 - Phone
- (859) 219-8632
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 38090 | KY | Primary |
Addresses
Primary practice location
3945 Peppertree Dr
Lexington, KY 40513-1398
Mailing address
3945 Peppertree Dr
Lexington, KY 40513-1398
Phone (859) 219-8632
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64920507 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441152000000",
"number": "1780604462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3945 PEPPERTREE DR",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405131398",
"telephone_number": "859-219-8632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3945 PEPPERTREE DR",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405131398",
"telephone_number": "859-219-8632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISESSA",
"first_name": "THOMAS",
"middle_name": "GERALD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2015-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "KY",
"license": "38090",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64920507",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.