Individual provider Active NPI

Melissa R Butler, NP

  • Adult Health Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1093763617
Registry record updated Jul 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F302431 Issued in NY
Practice address
5719 Widewaters Pkwy
Syracuse, NY 13214-1985
Phone
(315) 251-3100
Fax
(315) 449-9923
NPI assigned
May 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F302431 NY Primary

Addresses

Primary practice location

5719 Widewaters Pkwy
Syracuse, NY 13214-1985

Mailing address

5824 Widewaters Pkwy
East Syracuse, NY 13057-3072
Phone (315) 251-3105

Other identifiers 1

IdentifierTypeStateIssuer
02694526MedicaidNY

Other names 1

  • Melissa R Higgins Former name

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
I20051114000832 NY Practitioner - Nurse Practitioner 5496774960 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

301 Prospect Ave
Syracuse, NY 13203-1807
Phone (315) 448-5111

5100 W Taft Rd
Liverpool, NY 13088-4841

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F302431NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Suny Health Science Center at Syracuse Adult Health CurrentSince Jan 16, 2025 Accepting new patients
Suny Health Science Center at Syracuse CurrentSince Jan 16, 2025 Accepting new patients
Syracuse Orthopedic Specialists, PLLC CurrentSince May 28, 2012 Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients
St Josephs Medical PC Past Accepting new patients

Locations

5824 Widewaters Pkwy
East Syracuse, NY 13057
Phone (315) 251-3105

5719 Widewaters Pkwy
Syracuse, NY 13214
Phone (315) 251-3110

750 E Adams St
Ste 2104
Syracuse, NY 13210
Phone (315) 464-2300

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

Interoperability endpoints

  • Direct secure messaging: mbutler163514@direct.upstate.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593993600000",
    "number": "1093763617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5824 WIDEWATERS PKWY",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130573072",
            "telephone_number": "315-251-3105",
            "fax_number": "315-552-6018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5719 WIDEWATERS PKWY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141985",
            "telephone_number": "315-251-3100",
            "fax_number": "315-449-9923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "MELISSA",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F302431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02694526",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "HIGGINS",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.