Gustavo Raul Depetris, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

196792 Issued in NY

Practice address

2322 30TH Ave
2ND Floor
Astoria, NY 11102-3255

Phone

(718) 956-7988

Fax

(718) 267-1990

NPI assigned

Jul 15, 2006

Last updated

Jul 8, 2007By 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 identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• VNS of Ny Home Care Chha Home health agency, New York, NY, CCN 337008
• North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: gdepetris66710@northwell.direct-ci.com

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.

• North Shore-Lij Medical PC

  dba NHPP Cardiology at Great Neck

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• North Shore - Lij Medical PC

  dba NSLIJ Medical In Queens

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD
• For-Med Medical

  dba Astoria Medical Group

  • Legal Medicine
  • Long Island City, NY
  • NPI 1720194012
  NPD (past)
• Icahn School of Medicine at Mount Sinai

  dba New York Eye & Ear Optical Shop

  • Eyewear Supplier
  • New York, NY
  • NPI 1760227466
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• North Shore University Hospital

  • General Acute Care Hospital
  • Manhasset, NY
  • NPI 1366459570
  Care Compare affiliation
• Visiting Nurse Service of New York Home Care II

  dba Visiting Nurse Service of New York Home Care

  • Home Health Agency
  • New York, NY
  • NPI 1528059805
  Care Compare affiliation

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942226410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2322 30TH AVE",
            "address_2": "2ND FLOOR",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111023255",
            "telephone_number": "718-956-7988",
            "fax_number": "718-267-1990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2322 30TH AVE",
            "address_2": "2ND FLOOR",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111023255",
            "telephone_number": "718-956-7988",
            "fax_number": "718-267-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPETRIS",
        "first_name": "GUSTAVO",
        "middle_name": "RAUL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "196792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01630524",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC ID",
            "identifier": "196792",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Deng
• Dental Care of Astoria PC
• Dental Health of Astoria,PC
• Dental Smiles for Kids, LLC (Dental Smiles for Kids Astoria)
• Dentalsmilep.C.
• Laura Derubeis-Byrne
• Jill Deruga
• Designer Optical of Steinway Street Inc.
• Richard W Desmond, M.D.
• Nadege Desrivieres

• Internal Medicine Physician in Astoria, NY
• Providers in Astoria, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.