Individual provider Active NPI

Ketisha Angelica De Roche, M.D

  • Gastroenterology Physician
  • Brooklyn, NY
National Provider Identifier
1790119493
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
283786 Issued in MA
Practice address
450 Clarkson Ave
Brooklyn, NY 11203-2012
Phone
(718) 270-1000
NPI assigned
Aug 29, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 283786 MA Primary

Addresses

Primary practice location

450 Clarkson Ave
Brooklyn, NY 11203-2012

Mailing address

450 Clarkson Avenue
Suny Downstate
Brooklyn, NY 10023
Phone (718) 270-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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

Enrollment IDStateProvider typePAC IDDetails
I20201202000404 MA Practitioner - Gastroenterology 2769893452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Berkshire Faculty Services IncGroup PAC ID 8224068424, 276 clinicians

Practice addresses (Care Compare)

725 N St
Pittsfield, MA 01201-4109
Phone (413) 447-2695

725 N Street Berkshire OB/GYN of
Mbu
Pittsfield, MA 01201-4109
Phone (413) 499-8570

777 N St
Suite 207
Pittsfield, MA 01201-4123
Phone (413) 499-8510

780 S Main St
Suite 2
Great Barrington, MA 01230-2149
Phone (413) 447-2498

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy99
Upper gastrointestinal (GI) endoscopy for acid reflux79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Berkshire Faculty Services Inc CurrentSince Sep 8, 2020 Accepting new patients
Fairview Hospital CurrentSince Sep 8, 2020 Accepting new patients

Locations

780 S Main St
Ste 2
Gt Barrington, MA 01230
Phone (413) 447-2498

725 North St
Pittsfield, MA 01201
Phone (413) 447-2839

Interoperability endpoints

  • Direct secure messaging: ketishaderoche@bfs.medalliesdirect.net

Organizations & group practices 2

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.

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": "1377734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1790119493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVENUE",
            "address_2": "SUNY DOWNSTATE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "10023",
            "telephone_number": "718-270-1000",
            "fax_number": "718-579-4836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012",
            "telephone_number": "718-270-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE ROCHE",
        "first_name": "KETISHA",
        "middle_name": "ANGELICA",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-29",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MA",
            "license": "283786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.