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DESTA ANTHONY MOBILE NP ADULT HEALTH, PLLC
NPI 1679188494
Nurse Practitioner - Adult Health in Manlius, NY

Active since September 09, 2020
8241 PENSTOCK WAY, MANLIUS, NY 13104(315) 413-3848(315) 692-4292 Get Directions Write a Review

NPPES record last updated: November 28, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 28, 2025, Sep 15, 2025, Sep 9, 2020 (3 updates tracked since 2020).

About Desta Anthony Mobile Np Adult Health, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DESTA ANTHONY MOBILE NP ADULT HEALTH, PLLC (NPI 1679188494) is a healthcare organization registered as an adult health in Manlius, New York and active in the NPI registry since September 2020. The organization lists Desta Rowena Anthony, Owner, as its authorized official.

NPPES Registry Identity

NPI1679188494
Entity TypeOrganization
Primary Taxonomy363LA2200X
Legal Business NameDESTA ANTHONY MOBILE NP ADULT HEALTH, PLLC
Location Address8241 PENSTOCK WAYManlius, NY 13104-9401
Mailing Address8241 Penstock WayManlius, NY 13104-9401 · (315) 559-1965 · Fax (833) 606-0692
Phone(315) 413-3848
Fax(315) 692-4292
Organization SubpartNo
Authorized OfficialDesta Rowena AnthonyOwner · (315) 559-1965
Enumeration DateSeptember 9, 2020
Last NPPES UpdateNovember 28, 20253 updates tracked since enumeration
NPPES CertifiedNovember 28, 2025
✔ NPI 1679188494 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
8241 PENSTOCK WAY, Manlius, NY 13104
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Desta Anthony Mobile Np Adult Health, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Desta Anthony Mobile Np Adult Health, PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Desta Anthony, ANP
Nurse Practitioner
NPI 1093721102
8241 PENSTOCK WAY
Manlius, NY 13104
(315) 559-1965
✔ PECOSSame address
Ann Macwan
Nurse Practitioner
NPI 1568138394
115 CREEK CIR
East Syracuse, NY 13057
(315) 452-5800
✔ PECOS8.4 mi
Stacie Corrigan, FNP-C
Nurse Practitioner
NPI 1114761483
750 E ADAMS ST
Syracuse, NY 13210
(315) 345-1006
✔ PECOS9.8 mi
Christopher Norman, MSN, APRN, AGPCNP-BC
Nurse Practitioner
NPI 1326442476
550 HARRISON ST SUITE A - GERIATRICS
Syracuse, NY 13202
(315) 464-5167
✔ PECOS✔ Accepts Medicare9.9 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2194882

Desta Anthony Mobile Np Adult Health PLLC · Manlius, NY
Expired · Oct 4, 2026
CLIA Number33D2194882
Laboratory TypePhysician Office
Certificate Effective DateOctober 5, 2024
Certificate Expiration DateOctober 4, 2026
Laboratory DirectorMs. Anthony Desta
Laboratory Phone(315) 413-3848
Laboratory LocationDesta Anthony Mobile Np Adult Health PLLC8241 Penstock Way, Manlius, NY 13104
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Desta Anthony Mobile Np Adult Health, PLLC's NPI number?

The NPI number for Desta Anthony Mobile Np Adult Health, PLLC is 1679188494. It was assigned to this organization in the NPPES registry on September 9, 2020.

Where is Desta Anthony Mobile Np Adult Health, PLLC located?

Desta Anthony Mobile Np Adult Health, PLLC is located at 8241 Penstock Way, Manlius, NY 13104. The listed phone number is (315) 413-3848.

What is Desta Anthony Mobile Np Adult Health, PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Is Desta Anthony Mobile Np Adult Health, PLLC enrolled in Medicare?

Yes. Desta Anthony Mobile Np Adult Health, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Desta Anthony Mobile Np Adult Health, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Desta Anthony Mobile Np Adult Health, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Desta Anthony Mobile Np Adult Health, PLLC was last updated on November 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.