NPIMap

Individual provider Active NPI

Nathanael Desire, D.O.

  • Internal Medicine Physician
  • Bellport, NY
National Provider Identifier
1922118652
Registry record updated Jul 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
216602 Issued in NY
Practice address
1 Station CT
BLDG a Suite 1
Bellport, NY 11713-2453
Phone
(631) 803-8247
Fax
(631) 803-8251
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 216602 NY Primary
Pediatrics Physician 208000000X 216602 NY

Addresses

Primary practice location

1 Station CT
BLDG a Suite 1
Bellport, NY 11713-2453

Mailing address

1 Station CT
BLDG a Suite 1
Bellport, NY 11713-2453
Phone (631) 803-8247

Other identifiers 1

IdentifierTypeStateIssuer
02502298MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040225000054 NY Practitioner - Internal MedicinePractitioner - Hospitalist 3577459742 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
New York College of Osteo Medicine of New York Institute of Technology, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stony Brook Internists University Faculty Practice Corporation 427 clinicians
Southwest Suffolk Medical PC 204 clinicians

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-1560

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-1560

1600 Brecknock Rd
Greenport, NY 11944-3100
Phone (631) 749-5910

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 642-9801

Lauterbur Dr
Stony Brook, NY 11794-0001
Phone (632) 638-1000

PO Box
Suite 1554
Stony Brook, NY 11790-0989

Hospital & facility affiliations

  • Extended Home Care Home health agency, Brooklyn, NY, CCN 337414
  • East End Hospice, Inc Hospice, Westhampton Beach, NY, CCN 331546
  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
  • St Charles Hospital Hospital, Port Jefferson, NY, CCN 330246
  • Peconic Landing at Southhold Nursing home, Greenport, NY, CCN 335842

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
216602NYMDPediatrics Physician

Practice roles (6 of 10)

OrganizationSpecialtyStatusNew patients
GPC Consultants LLC Internal Medicine Current Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Dec 1, 2020 Accepting new patients
Leisure Village Medical Services PLLC Current Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Internal Medicine CurrentSince Dec 1, 2020 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients
North Fork House Calls, LLC PastSince Sep 9, 2015 Accepting new patients

Locations

1600 Brecknock Rd
Greenport, NY 11944
Phone (631) 477-3800

200 Belle Terre Rd
Prt Jefferson, NY 11777
Phone (631) 474-6000

200 Belle Terre Rd
Ste 110
Prt Jefferson, NY 11777
Phone (631) 476-1010

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: nathanael.desiredo@sbcm.cernerdirect.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Hamlet Rehabilitation and Healthcare Center at NesconsetNesconset, NY, CCN 335674 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 1, 2024
Mar 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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 10

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1922118652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 STATION CT",
            "address_2": "BLDG A SUITE 1",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "117132453",
            "telephone_number": "631-803-8247",
            "fax_number": "631-803-8251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 STATION CT",
            "address_2": "BLDG A SUITE 1",
            "city": "BELLPORT",
            "state": "NY",
            "postal_code": "117132453",
            "telephone_number": "631-803-8247",
            "fax_number": "631-803-8251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESIRE",
        "first_name": "NATHANAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "216602",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "216602",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02502298",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellport, NY

Sources for this page

Verify at the official NPI Registry.