Individual provider Active NPI

Jacob Mir, PA-C

  • Physician Assistant
  • Liverpool, NY
National Provider Identifier
1043054158
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
7375 Oswego Rd
Liverpool, NY 13090-3717
Phone
(315) 291-0064
NPI assigned
Jun 24, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

7375 Oswego Rd
Liverpool, NY 13090-3717

Mailing address

2744 Hiltonwood Rd
Baldwinsville, NY 13027-8207
Phone (315) 391-6094

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240829000705 NY Practitioner - Physician Assistant 6305385766 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellnow Urgent Care, P.C.Group PAC ID 8325320864, 395 clinicians

Practice addresses (Care Compare)

1600 Erie Blvd E
Syracuse, NY 13210-1212
Phone (315) 401-3204

3800 W Genesee St
Syracuse, NY 13219-1928
Phone (315) 552-9080

3840 State Route 31
Liverpool, NY 13090-1310
Phone (315) 715-6319

4995 Wintersweet Dr
Liverpool, NY 13088-2176
Phone (315) 401-3210

6227 Thompson Rd
Syracuse, NY 13206-1405
Phone (315) 937-2007

6870 E Genesee St
Fayetteville, NY 13066-1031
Phone (315) 679-4367

7375 Oswego Rd
Suite 1
Liverpool, NY 13090-3717
Phone (315) 291-0064

8003 Brewerton Rd
Cicero, NY 13039-9528
Phone (315) 288-4006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
032303NYMDMassage Therapist

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": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1043054158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2744 HILTONWOOD RD",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130278207",
            "telephone_number": "315-391-6094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7375 OSWEGO RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130903717",
            "telephone_number": "315-291-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIR",
        "first_name": "JACOB",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.