Individual provider Active NPI

Chad J. Demarche, PA

  • Physician Assistant
  • Watertown, NY
National Provider Identifier
1780936872
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
016396 Issued in NY
Practice address
830 Washington St
Watertown, NY 13601-4034
Phone
(315) 788-1751
Fax
(315) 788-9021
NPI assigned
Oct 12, 2012
Last updated
May 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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 016396 NY Primary

Addresses

Primary practice location

830 Washington St
Watertown, NY 13601-4034

Mailing address

830 Washington St
Watertown, NY 13601-4034
Phone (315) 788-1751

Other identifiers 1

IdentifierTypeStateIssuer
03583451MedicaidNY

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
I20130304000202 NY Practitioner - Physician Assistant 8325293020 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Samaritan Medical CenterGroup PAC ID 8123914876, 157 clinicians

Practice addresses (Care Compare)

10881 US Route 11
Adams, NY 13605-3154
Phone (315) 232-4400

629 Washington St
Watertown, NY 13601-4836
Phone (315) 755-3451

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
016396NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Medical Center CurrentSince May 1, 2023 Accepting new patients
New York Anesthesiology Medical Specialties, PC Past Accepting new patients
Watertown Ear Nose and Throat GRP Past Accepting new patients
Samaritan Medical Center Past Accepting new patients
Syracuse Orthopedic Specialists, PLLC Past Accepting new patients

Locations

830 Washington St
Watertown, NY 13601
Phone (315) 785-4000

Interoperability endpoints

  • Direct secure messaging: cdemarche@samaritanmedicalpractice.medentdirect.com

Organizations & group practices 5

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 1

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": "1350000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1780936872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014034",
            "telephone_number": "315-788-1751",
            "fax_number": "315-788-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014034",
            "telephone_number": "315-788-1751",
            "fax_number": "315-788-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMARCHE",
        "first_name": "CHAD",
        "middle_name": "J.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-12",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03583451",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

Verify at the official NPI Registry.