Active NPI
Nysarc Inc. Onondaga County Chapter
- Developmental Disabilities Clinic/Center
- Syracuse, NY
National Provider Identifier
1043397490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Disabilities Clinic/Center
- Legal business name
- NYSARC INC. ONONDAGA COUNTY CHAPTER
- Practice address
- 600 S Wilbur Ave
Syracuse, NY 13204-2730 - Phone
- (315) 476-7441
- Fax
- (315) 424-6001
- NPI assigned
- Nov 1, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Stanfort J. Perry
- Title
- Execuitive Director
- Phone
- (315) 476-7441
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Disabilities Clinic/Center | 261QD1600X | Primary |
Addresses
Primary practice location
600 S Wilbur Ave
Syracuse, NY 13204-2730
Mailing address
600 S Wilbur Ave
Syracuse, NY 13204-2730
Phone (315) 476-7441
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00560238 | Medicaid | NY | |
| 01474799 | Medicaid | NY | |
| 01162096 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070912000594 | NY | Part B Supplier - Clinic/Group Practice | 9537252184 |
Receives reassigned benefits from 21 practitioners Practice locations: Liverpool, NY; Watertown, NY; Syracuse, NY; Oneonta, NY; Norwood, NY; East Syracuse, NY; Canton, NY |
National Provider Directory
National Provider Directory- Tax ID family
- Nysarc Inc Onondaga County Chapter
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Early Intervention Provider Agency
- Syracuse, NY
- NPI 1598996571
Practitioners & affiliated clinicians
Practitioners 22
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1187740800000",
"number": "1043397490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 S WILBUR AVE",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132042730",
"telephone_number": "315-476-7441",
"fax_number": "315-424-6001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 S WILBUR AVE",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132042730",
"telephone_number": "315-476-7441",
"fax_number": "315-424-6001"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NYSARC INC. ONONDAGA COUNTY CHAPTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-01",
"last_updated": "2007-08-22",
"status": "A",
"authorized_official_last_name": "PERRY",
"authorized_official_first_name": "STANFORT",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "EXECUITIVE DIRECTOR",
"authorized_official_telephone_number": "315-476-7441",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QD1600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00560238",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01474799",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01162096",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}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 Aug 22, 2007; 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.