Andrew X Destefano, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

20296 Issued in MA

Practice address

262 Willow Ave Apt 2
Somerville, MA 02144-2263

Phone

(617) 863-7003

NPI assigned

Oct 31, 2012

Last updated

Jul 21, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kristen R Destefano Former name

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pinnacle Rehabilitation Network LLCGroup PAC ID 7618872086, 105 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1148/brand/1/csg/1/fhir/r4

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.

• Pinnacle Rehabilitation Network, LLC

  dba Blue Hills Physical Therapy

  • Physical Therapist
  • Braintree, MA
  • NPI 1679582175
  Medicare reassignment Care Compare group NPD
• Pinnacle Rehabilitation Network LLC

  dba Waypoint Physical Therapy

  • Physical Therapist
  • Freeport, ME
  • NPI 1235940388
  NPD
• Pro Sports Therapy, Inc.

  • Physical Therapist
  • Waltham, MA
  • NPI 1780661090
  NPD (past)

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595289600000",
    "number": "1831443720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 WILLOW AVE APT 2",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021442263",
            "telephone_number": "617-863-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 WILLOW AVE APT 2",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021442263",
            "telephone_number": "617-863-7003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Lancaster St",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021141704",
            "country_code": "US",
            "telephone_number": "617-367-4700",
            "fax_number": "617-367-4701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "ANDREW",
        "middle_name": "X",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-31",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "20296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "DESTEFANO",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nikita Desai, WHNP-BC
• Prium Deshmukh, M.D.
• Manouchka Desir
• Nadege Desir, LPN
• Nicolas Junior Desjardins, PA-C
• Chrysnell Destina, EMT-B
• Giselle Devane
• Emily Devlin
• Marriann Dew, PA-C
• Natalie Diacovo

• Physical Therapist in Somerville, MA
• Providers in Somerville, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.