William J. Flynn III, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4623 Issued in NY

Practice address

11050 Mount Belvedere Blvd
USA Meddac Attn: Credentials
Fort Drum, NY 13602-5438

Phone

(315) 772-4025

Fax

(315) 772-9498

NPI assigned

Dec 22, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303948800000",
    "number": "1104802941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "address_2": "USA MEDDAC ATTN: CREDENTIALS",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-772-4025",
            "fax_number": "315-772-9498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "address_2": "USA MEDDAC ATTN: CREDENTIALS",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-772-4025",
            "fax_number": "315-772-9498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLYNN",
        "first_name": "WILLIAM",
        "middle_name": "J.",
        "name_suffix": "III",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2011-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "4623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin L Favret, PTA
• Susan Felicia
• Michael D Figueroa, PH.D.
• Arthur Brian Fisch, D.P.M., RPH
• Tammy Lynne Fish, LCSW
• Donald Foster, DDS
• Elizabeth Haley Fowler, RDH
• Vladimir Fridkin, MD
• Savannah Fuller Bartlett, OTR/L, CHT
• Emily Elizabeth Gaffney, PT, DPT

• Physician Assistant in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.