NPIMap

Individual provider Active NPI

Desiree Villeneuve, PA-C

  • Medical Physician Assistant
  • Dover, NH
National Provider Identifier
1962910604
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1496 Issued in NH
Practice address
789 Central Ave
Dover, NH 03820-2526
Phone
(603) 742-8787
Fax
(603) 740-2446
NPI assigned
Jan 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1496 NH Primary
Physician Assistant 363A00000X PA6432 MA
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

789 Central Ave
Dover, NH 03820-2526

Mailing address

789 Central Ave
Dover, NH 03820-2526

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180406000958 MA Practitioner - Physician Assistant 3173886017 Reassigns benefits to 2 organizations
I20190819000940 NH Practitioner - Physician Assistant 3173886017 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wentworth Douglass Physician CorporationGroup PAC ID 5496749848, 429 clinicians

Practice addresses (Care Compare)

789 Central Ave
Dover, NH 03820-2526

Hospital & facility affiliations

  • Wentworth-Douglass Hospital Hospital, Dover, NH, CCN 300018
  • Huggins Hospital Hospital, Wolfeboro, NH, CCN 301312

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA6432MAMDPhysician Assistant
1496NHMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wentworth Douglass Physician Corporation CurrentSince Jul 6, 2019 Accepting new patients
Wentworth Douglass Hospital Current Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince Sep 12, 2024 Accepting new patients
The Mercy Hospital Inc Past Accepting new patients
Westchester Neurological Consultant PC Past Accepting new patients

Locations

55 Fruit St
Boston, MA 02114

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

750 Central Ave
Ste Q
Dover, NH 03820
Phone (603) 742-6030

121 Corporate Dr
Bldg C
Portsmouth, NH 03801
Phone (603) 740-8787

67 Corporate Dr
#300
Portsmouth, NH 03801
Phone (603) 516-0092

Interoperability endpoints

  • Direct secure messaging: villeneuve.desiree.wdh@direct.partners.masshiway.net
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 8

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 5

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": "1516060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1962910604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202526",
            "telephone_number": "603-742-8787",
            "fax_number": "603-740-2446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLENEUVE",
        "first_name": "DESIREE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-16",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NH",
            "license": "1496",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA6432",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, NH

Sources for this page

Verify at the official NPI Registry.