NICHOLAS CARROLL DESTEFANO MD
NPI 1154776755
General Practice in Fort Gordon, GA
NPI Status: Active since May 02, 2016
Contact Information
300 E HOSPITAL RD
FORT GORDON, GA
ZIP 30905
Phone: (706) 383-5299
- Individual
- Male
- General Practice
- PECOS Enrolled
About NICHOLAS DESTEFANO
This page provides the complete NPI Profile along with additional information for Nicholas Destefano, a primary care provider established in Fort Gordon, Georgia with a medical specialization in General Practice. The healthcare provider is registered in the NPI registry with number 1154776755 assigned on May 2016. The practitioner's primary taxonomy code is 208D00000X with license number 30177 (NE). The provider is registered as an individual and his NPI record was last updated December 2025.
- NPI
- 1154776755
- Provider Name
- NICHOLAS CARROLL DESTEFANO MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 300 E HOSPITAL RD FORT GORDON, GA 30905
- Location Phone
- (706) 383-5299
- Mailing Address
- 300 E HOSPITAL RD FORT GORDON, GA 30905
- Mailing Phone
- (706) 383-5299
- Is Sole Proprietor?
- No
- Enumeration Date
- 05-02-2016
- Last Update Date
- 12-10-2025
- Code Navigator
A primary care provider (PCP) like Nicholas Destefano sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Secondary Locations
- 21635 Biden Ave Unit 101
Georgetown, DE 19947
(302) 856-9596 - 36223 Farm Ln Ste 140
Rehoboth Beach, DE 19971
(302) 227-1268 - 1008 Kings Hwy
Lewes, DE 19958
(302) 291-6031 - 36450 Tidal Rd Unit 2
Selbyville, DE 19975
(302) 291-6045 - 18947 John J Williams Hwy Unit 303
Rehoboth Beach, DE 19971
(302) 644-0690 - 23900 Milton Ellendale Hwy Ste 101
Milton, DE 19968
(302) 684-2033 - 32050 Long Neck Rd
Millsboro, DE 19966
(302) 645-3150 - 424 Savannah Rd
Lewes, DE 19958
(302) 645-3150 - 12100 Black Swan Dr Ste 104
Lewes, DE 19958
(302) 645-1315 - 17388 N Village Main Blvd Unit 21
Lewes, DE 19958
(302) 291-6050 - 100 Silicato Pkwy Ste 201
Milford, DE 19963
(302) 393-2056 - 28538 DuPont Blvd Unit 1
Millsboro, DE 19966
(302) 829-3294 - 232 Mitchell St Unit 301
Millsboro, DE 19966
(302) 316-4190 - 32550 Docs Pl Unit 2
Millville, DE 19967
(302) 539-4302
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
General Practice
- Taxonomy Code
- 208D00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 30177
- License State
- NE
- Taxonomy Description
- A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | C1-0028577 (DE) |
Medicare Participation & PECOS Enrollment Status
Nicholas Destefano is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1154776755, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 55 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
FORT GORDON, GA 30905
FT. GORDON, GA 30905
FT GORDON, GA 30905
FORT GORDON, GA 30905
FT GORDON, GA 30905
FORT GORDON, GA 30905
FORT GORDON, GA 30905
FORT GORDON, GA 30905
FORT GORDON, GA 30905
FORT GORDON, GA 30905
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1154776755, enumerated as an "individual" on May 02, 2016.
The provider is located at 300 E HOSPITAL RD FORT GORDON, GA 30905 and the phone number is (706) 383-5299.
General Practice with taxonomy code 208D00000X.
