NPIMap

Organization Active NPI

Associated Gastroenterologists of Central New York, PC

  • Gastroenterology Physician
  • Camillus, NY
National Provider Identifier
1013938174
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
ASSOCIATED GASTROENTEROLOGISTS OF CENTRAL NEW YORK, PC
Practice address
260 Township Blvd
Ste 20
Camillus, NY 13031
Phone
(315) 708-0190
Fax
(315) 488-3284
NPI assigned
Jul 22, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Carol Gallup
Title
Credentialing Coordinator
Phone
(315) 218-0085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NY Primary

Addresses

Primary practice location

260 Township Blvd
Ste 20
Camillus, NY 13031

Mailing address

260 Township Blvd
Ste 20
Camillus, NY 13031
Phone (315) 708-0091

Other practice location 1

4870 Broad Rd
Suite 3Q
Syracuse, NY 13215-2206
Phone (315) 492-5765

Other identifiers 3

IdentifierTypeStateIssuer
CF1049OtherNYR/R MEDICARE
CC7979OtherNYR/R MEDICARE
00482137MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040928000914 NY Part B Supplier - Clinic/Group Practice 3375512213 Receives reassigned benefits from 19 practitioners
Practice locations: Camillus, NY; East Syracuse, NY; Fayetteville, NY; Liverpool, NY

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

4939 Brittonfield Pkwy
Ste 209
East Syracuse, NY 13057
Phone (315) 218-0085

4217 Medical Center Dr
Fayetteville, NY 13066
Phone (315) 329-7300

5100 W Taft Rd
Ste 3C
Liverpool, NY 13088
Phone (315) 452-2214

4870 Broad Rd
#1049
Syracuse, NY 13215

4870 Broad Rd
Ste 3Q
Syracuse, NY 13215
Phone (315) 492-5292

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1013938174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 TOWNSHIP BLVD",
            "address_2": "STE 20",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "13031",
            "telephone_number": "315-708-0091",
            "fax_number": "315-708-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 TOWNSHIP BLVD",
            "address_2": "STE 20",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "13031",
            "telephone_number": "315-708-0190",
            "fax_number": "315-488-3284"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4870 Broad Rd",
            "address_2": "Suite 3Q",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132152206",
            "country_code": "US",
            "telephone_number": "315-492-5765",
            "fax_number": "315-492-5123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ASSOCIATED GASTROENTEROLOGISTS OF CENTRAL NEW YORK, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "GALLUP",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "315-218-0085"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R/R MEDICARE",
            "identifier": "CF1049",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R/R MEDICARE",
            "identifier": "CC7979",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00482137",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camillus, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.