Active NPI
Joseph Leonard Destefano, MD
- Psychiatry Physician
- Lafayette, IN
National Provider Identifier
1790928216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 01042109A
- Practice address
- 1116 N 16TH St
Lafayette, IN 47904-2119 - Phone
- (765) 423-6300
- Fax
- (765) 423-6301
- NPI assigned
- Apr 14, 2009
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 01042109A | IN | Primary |
Addresses
Primary practice location
1116 N 16TH St
Lafayette, IN 47904-2119
Mailing address
1040 Sierra Dr
Suite 400 Attn: Mary Dean
Greenwood, IN 46143-7240
Phone (317) 865-8797
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201069420L | Medicaid | IN | |
| 200080730 | Medicaid | IN |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana University Psychiatric Associates, Inc. | Psychiatry | Past | Accepting new patients |
| Indiana Health Group Inc | Psychiatry | Past | Accepting new patients |
| St. Vincent Hospital & Health Care Center, Inc. | Psychiatry | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Carmel, IN
- NPI 1356396295
Psychiatry
-
- Psychiatry Physician
- Indianapolis, IN
- NPI 1023063724
-
- Psychiatry Physician
- Indianapolis, IN
- NPI 1689869893
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482883200000",
"number": "1790928216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1040 SIERRA DR",
"address_2": "SUITE 400 ATTN: MARY DEAN",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461437240",
"telephone_number": "317-865-8797",
"fax_number": "317-859-8552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1116 N 16TH ST",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042119",
"telephone_number": "765-423-6300",
"fax_number": "765-423-6301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTEFANO",
"first_name": "JOSEPH",
"middle_name": "LEONARD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-14",
"last_updated": "2016-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IN",
"license": "01042109A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201069420L",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200080730",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.