Individual provider Active NPI

Michael Hlywa, PT

  • Specialist
  • Baldwinsville, NY
National Provider Identifier
1013099878
Registry record updated Feb 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
13530 Issued in NY
Practice address
3070 Belgium Rd
Baldwinsville, NY 13027-9239
Phone
(315) 638-0173
Fax
(315) 638-0754
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 13530 NY Primary
Physical Therapist 225100000X

Addresses

Primary practice location

3070 Belgium Rd
Baldwinsville, NY 13027-9239

Mailing address

207 Pine St
Syracuse, NY 13210-1137
Phone (315) 476-3175

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120118000208 NY Practitioner - Physical Therapist in Private Practice 0547437469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
State University of New York Downstate Medical Center, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peterson and Nellis Physical Therapy PCGroup PAC ID 8022007756, 5 clinicians

Practice addresses (Care Compare)

207 Pine St
Syracuse, NY 13210-1137
Phone (315) 476-3176

3090 Belgium Rd
Baldwinsville, NY 13027-9239
Phone (315) 638-0173

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13530NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Peterson & Nellis Physical Therapy PC Specialist CurrentSince Jan 1, 1999 Accepting new patients

Locations

3090 Belgium Rd
#31
Baldwinsville, NY 13027

3070 Belgium Rd
Baldwinsville, NY 13027
Phone (315) 635-5700

3090 Belgium Rd
Baldwinsville, NY 13027
Phone (315) 638-0173

3400 Seneca Tpke
Ste 7
Canastota, NY 13032
Phone (315) 697-8514

207 Pine St
Syracuse, NY 13210
Phone (315) 476-3175

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297296000000",
    "number": "1013099878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 PINE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101137",
            "telephone_number": "315-476-3175",
            "fax_number": "315-476-0171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3070 BELGIUM RD",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130279239",
            "telephone_number": "315-638-0173",
            "fax_number": "315-638-0754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HLYWA",
        "first_name": "MICHAEL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2011-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "13530",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baldwinsville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.