NPIMap

Organization Active NPI

Nysarc Inc.

  • Developmental Disabilities Clinic/Center
  • Newark, NY
National Provider Identifier
1043414170
Registry record updated Dec 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
License
60530473 Issued in NY
Legal business name
NYSARC INC.
Practice address
150 Van Buren St
Newark, NY 14513-1238
Phone
(315) 331-7741
NPI assigned
Jun 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2007

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

Authorized official

Name
Mr. David Calhoun
Title
Executive Director
Phone
(315) 331-7741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X 60530473 NY Primary

Addresses

Primary practice location

150 Van Buren St
Newark, NY 14513-1238

Mailing address

150 Van Buren St
Newark, NY 14513-1238
Phone (315) 331-7741

Other identifiers 1

IdentifierTypeStateIssuer
02870395MedicaidNY

Other names 1

  • Wayne County Chapter Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071212000032 NY Part B Supplier - Clinic/Group Practice 0840380044 Receives reassigned benefits from 22 practitioners
Practice locations: Albion, NY; Elba, NY; Newark, NY

National Provider Directory

National Provider Directory
Tax ID family
Roosevelt Childrens Center11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

215 Washington St
Albion, NY 14411
Phone (585) 490-2080

4603 Barrville Rd
Elba, NY 14058

150 Van Buren St
Newark, NY 14513
Phone (315) 331-7741

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1043414170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 VAN BUREN ST",
            "city": "NEWARK",
            "state": "NY",
            "postal_code": "145131238",
            "telephone_number": "315-331-7741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 VAN BUREN ST",
            "city": "NEWARK",
            "state": "NY",
            "postal_code": "145131238",
            "telephone_number": "315-331-7741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NYSARC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "CALHOUN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-331-7741",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NY",
            "license": "60530473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02870395",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne County Chapter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newark, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.

Verify at the official NPI Registry.