Individual provider Active NPI

Panayotis Petrou, PHD

  • Clinical Psychologist
  • Syracuse, NY
National Provider Identifier
1144304072
Registry record updated Dec 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
12772-1 Issued in NY
Practice address
600 E Genesee St
217
Syracuse, NY 13202-3130
Phone
(315) 422-0300
Fax
(315) 479-8455
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 12772-1 NY Primary

Addresses

Primary practice location

600 E Genesee St
217
Syracuse, NY 13202-3130

Mailing address

600 E Genesee St
217
Syracuse, NY 13202-3130
Phone (315) 422-0300

Other identifiers 1

IdentifierTypeStateIssuer
01691845MedicaidNY

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111019000921 NY Practitioner - Clinical Psychologist 1153593967 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of Kentucky College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychiatry Services of New York, PCGroup PAC ID 9133534340, 34 clinicians

Practice addresses (Care Compare)

3300 James St
Suite 100
Syracuse, NY 13206-2392
Phone (315) 422-0300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
12772-1NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatry Services of New York PC CurrentSince Feb 20, 2024 Accepting new patients
Psychiatry Services of New York, P.C. CurrentSince Feb 20, 2024 Accepting new patients
Psychological Healthcare, PLLC CurrentSince Sep 1, 1996 Accepting new patients

Locations

8289 Loop Rd
Baldwinsville, NY 13027
Phone (315) 452-0300

890 7th North St
Ste 100
Liverpool, NY 13088

890 7th North St
Ste 200
Liverpool, NY 13088
Phone (315) 200-1056

600 E Genesee St
Ste 217
Syracuse, NY 13202
Phone (315) 452-0300

3300 James St
Ste 100
Syracuse, NY 13206

Interoperability endpoints

  • Direct secure messaging: panayotis.petrou.1@28623.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/28623/brand/6/csg/1/fhir/r4

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292803200000",
    "number": "1144304072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E GENESEE ST",
            "address_2": "217",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023130",
            "telephone_number": "315-422-0300",
            "fax_number": "315-479-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E GENESEE ST",
            "address_2": "217",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023130",
            "telephone_number": "315-422-0300",
            "fax_number": "315-479-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROU",
        "first_name": "PANAYOTIS",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2010-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "12772-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01691845",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.