JACK V. DITEODORO M.D,LLC
NPI 1700194636
Point of Service in Stamford, CT
About Jack V. Diteodoro M.d,llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACK V. DITEODORO M.D,LLC (NPI 1700194636) is a healthcare organization registered as a point of service in Stamford, Connecticut and active in the NPI registry since September 2010. The organization lists Jack V Diteodoro, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jack V. Diteodoro M.d,llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Jack V. Diteodoro M.D,llc, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (4)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Jack V. Diteodoro M.D,llc's NPI number?
The NPI number for Jack V. Diteodoro M.D,llc is 1700194636. It was assigned to this organization in the NPPES registry on September 14, 2010.
Where is Jack V. Diteodoro M.D,llc located?
Jack V. Diteodoro M.D,llc is located at 90 Morgan Steet Stuite 303, Stamford, CT 06905. The listed phone number is (203) 323-6873.
What is Jack V. Diteodoro M.D,llc's specialty?
The primary specialty registered for this NPI is Point of Service with taxonomy code 305S00000X.
Is Jack V. Diteodoro M.D,llc enrolled in Medicare?
Yes. Jack V. Diteodoro M.D,llc is registered in the Medicare PECOS enrollment system.
When is Jack V. Diteodoro M.D,llc's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Connecticut, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Jack V. Diteodoro M.D,llc?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Jack V. Diteodoro M.D,llc. 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. The largest specialties are Nurse Practitioner (3) and Family Practice (1). Of these, 1 practice at this address and 2 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 Jack V. Diteodoro M.D,llc was last updated on September 14, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years 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.
# Jack V. Diteodoro M.d,llc · NPI 1700194636
Point of Service organization in Stamford, Connecticut. Organization record, active in the CMS NPPES registry since September 14, 2010.
## Identity
- **NPI:** 1700194636 (Entity type: Organization)
- **Enumerated:** September 14, 2010
- **Primary specialty:** Point of Service · taxonomy 305S00000X
- **Organization subpart:** No
- **Authorized official:** Jack Diteodoro, OWNER
## Practice location
- **Address:** 90 MORGAN STEET STUITE 303, Stamford, CT 06905-5436
- **Phone:** (203) 323-6873
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Connecticut, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 4 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (3), Family Practice (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 14, 2010
- **Other identifiers:** Medicare UPIN G43319 (CT); Medicaid 001355587 (CT)
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Source: [NPI Profile](https://npiprofile.com/npi/1700194636) · Data from the CMS NPPES public registry.