Active NPI
Kathleen M Shefner, M.D.
- Pediatrics Physician
- Syracuse, NY
National Provider Identifier
1033220934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 221218
- Practice address
- 475 Irving Ave
Suite 210
Syracuse, NY 13210-1756 - Phone
- (315) 471-2646
- Fax
- (315) 471-1762
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 221218 | NY | Primary |
Addresses
Primary practice location
475 Irving Ave
Suite 210
Syracuse, NY 13210-1756
Mailing address
475 Irving Ave
Suite 210
Syracuse, NY 13210-1756
Phone (315) 471-2646
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 040426016033 | Other | FIDELIS | |
| 02212480 | Medicaid | NY | |
| 265416 | Other | MVP INSURANCE # |
Other names 1
- Dr. Kathleen M Hykin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Madison Irving Pediatrics, PC | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/3682/brand/1/csg/1/fhir/r4
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.
-
- Pediatric Adolescent Medicine Physician
- East Syracuse, NY
- NPI 1063576312
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358294400000",
"number": "1033220934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 IRVING AVE",
"address_2": "SUITE 210",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132101756",
"telephone_number": "315-471-2646",
"fax_number": "315-471-1762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 IRVING AVE",
"address_2": "SUITE 210",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132101756",
"telephone_number": "315-471-2646",
"fax_number": "315-471-1762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEFNER",
"first_name": "KATHLEEN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2013-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "221218",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS",
"identifier": "040426016033",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02212480",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP INSURANCE #",
"identifier": "265416",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KATHLEEN",
"last_name": "HYKIN",
"middle_name": "M",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.