Individual provider Active NPI

James David Vanness, P.A.

  • Physician Assistant
  • Plattsburgh, NY
National Provider Identifier
1154721546
Registry record updated Dec 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0177991 Issued in NY
Practice address
8 Broad St
Plattsburgh, NY 12901-3420
Phone
(518) 825-1555
Fax
(518) 825-1550
NPI assigned
Sep 4, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0177991 NY Primary

Addresses

Primary practice location

8 Broad St
Plattsburgh, NY 12901-3420

Mailing address

439 State Route 22B
Peru, NY 12972-5423
Phone (518) 643-0072

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
I20141108000117 NY Practitioner - Physician Assistant 6103048087 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Country Behavioral Medicine PLLCGroup PAC ID 2668744756, 22 clinicians

Practice addresses (Care Compare)

8 Broad St
Plattsburgh, NY 12901-3420
Phone (518) 825-1555

Hospital & facility affiliations

  • The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
017799NYMDPhysical Therapist
0177991NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Citizen Advocates, Inc PastSince Aug 14, 2022 Accepting new patients

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.

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": "1409788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702166400000",
    "number": "1154721546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "439 STATE ROUTE 22B",
            "city": "PERU",
            "state": "NY",
            "postal_code": "129725423",
            "telephone_number": "518-643-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 BROAD ST",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129013420",
            "telephone_number": "518-825-1555",
            "fax_number": "518-825-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANNESS",
        "first_name": "JAMES",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-04",
        "last_updated": "2023-12-10",
        "certification_date": "2023-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "0177991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plattsburgh, NY

Sources for this page

Verify at the official NPI Registry.