Ashley Marie Maxam

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

5417 W Genesee St Ste 3
Camillus, NY 13031-2177

Phone

(315) 470-7409

NPI assigned

Apr 20, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ashley Marie McCann Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Crouse Health Inc.

  • Substance Abuse Rehabilitation Facility
  • Syracuse, NY
  • NPI 1265459945
  NPD (past)
• Crouse Medical Practice, PLLC

  • Internal Medicine Physician
  • Syracuse, NY
  • NPI 1922321934
  NPD (past)
• Syracuse University

  • Student Health Clinic/Center
  • Syracuse, NY
  • NPI 1447338819
  NPD (past)

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

{
    "created_epoch": "1555718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1144883505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST STE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042866",
            "telephone_number": "315-937-3433",
            "fax_number": "315-701-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5417 W GENESEE ST STE 3",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312177",
            "telephone_number": "315-470-7409"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "739 Irving Ave Ste 340",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132101605",
            "country_code": "US",
            "telephone_number": "315-470-7747",
            "fax_number": "315-470-7758",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAXAM",
        "first_name": "ASHLEY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-20",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "amaxam@crousemed.medentdirect.com",
            "affiliation": "Y",
            "endpointDescription": "email address in Medent",
            "affiliationName": "Crouse Medical Practice, PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "5417 W Genesee St Ste 3",
            "city": "Camillus",
            "state": "NY",
            "country_code": "US",
            "postal_code": "130312177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ASHLEY",
            "last_name": "MCCANN",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Christopher Manfredi, M.D.
• Stephen N Marshall, DPM
• Vincent Patrick Massaro
• Stephanie Ann Masterman, OPT
• Heather Mauro
• Maxim
• Kathryn McAvan, RN
• Abigail McCarthy, PA
• Melissa Marie McEnaney, R.N.
• Jaclyn Marie McGee, MS, CCC-SLP

• Physician Assistant in Camillus, NY
• Providers in Camillus, 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 Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.