Rebecca Mae Goal Carroll, PT
Individual provider Active NPI Physical Therapist · Camillus, NY
NPI 1093045155 · NPPES record last updated Aug 6, 2018
Key facts
- NPI
- 1093045155
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 032288 (NY)
- Practice address
- 5417 W Genesee St
Camillus, NY 13031 - Phone
- (315) 418-4043
- Fax
- (315) 469-1324
- NPI assigned
- Jan 12, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Syracuse Orthopedic Specialists, PLLC
Practice addresses (Care Compare)
5823 Widewaters Pkwy
Suite 3
East Syracuse, NY 13057-3081
Phone (315) 418-4000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100728000583 | NY | Practitioner - Physical Therapist in Private Practice | 3375676315 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 032288 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Syracuse Orthopedic Specialists, PLLC | Current |
Accepting new patients | |
| Syracuse Orthopedic Specialists, PLLC | Past |
Accepting new patients |
Locations
5417 W Genesee St
Camillus, NY 13031
Phone (315) 418-4043
5823 Widewaters Pkwy
East Syracuse, NY 13057
Phone (315) 426-0190
5823 Widewaters Pkwy
Ste 3
East Syracuse, NY 13057
Phone (315) 418-4000
1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488
5719 Widewaters Pkwy
Syracuse, NY 13214
Phone (315) 251-3110
4994 W Seneca Tpke
Syracuse, NY 13215
Phone (315) 469-5400
Interoperability endpoints
- rgoal@sosbones.medentdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 032288 | NY | Yes |
Addresses
Primary practice location
5417 W Genesee St
Camillus, NY 13031
Mailing address
5823 Widewaters Pkwy
East Syracuse, NY 13057-3084
Phone (315) 418-4013
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AA0172 | Other | MCR GROUP | |
| 02052091 | Other | NY | MEDICAID GRP |
| AA0171 | Other | MCR GROUP | |
| PENDING | Medicaid | NY | |
| 1710923222 | Other | GRP NPI |
Other providers in Camillus, NY
- Stacey T Cappon
- Ellen Lynne Carey
- Roxanne Marie Carey
- Barbara Carkey
- Nicolelynn Marie Carroccio
- William R. Caryl, Jr.
- Jennifer Susan Castro
- Jennifer Anne Catney
- Desiderio M Catunto
- Stephanie Cavallaro
All providers in Camillus, NY · Physical Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.