Individual provider Active NPI

Carla A Vavala, PA

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1164422366
Registry record updated Nov 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
010379 Issued in NY
Practice address
736 Irving Ave
Syracuse, NY 13210-1687
Phone
(315) 470-7551
Fax
(315) 470-2719
NPI assigned
Jul 29, 2005
Last updated
Nov 19, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2008

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 010379 NY Primary

Addresses

Primary practice location

736 Irving Ave
Syracuse, NY 13210-1687

Mailing address

PO Box 2004
East Syracuse, NY 13057-4504
Phone (315) 362-5285

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
I20050420001279 NY Practitioner - Physician Assistant 7012955966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

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

Merit-based Incentive Payment System (MIPS)

Final score
90.28 of 100Reported as group
Quality
95.25
Improvement activities
40
Cost
76.32

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
010379NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
New York Anesthesiology Medical Specialties, PC CurrentSince Jul 1, 2011 Accepting new patients
New York Anesthesiology Medical Specialties PC CurrentSince Jul 1, 2011 Accepting new patients

Locations

5417 W Genesee St
Ste 1
Camillus, NY 13031
Phone (315) 432-4900

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

5496 E Taft Rd
Syracuse, NY 13212
Phone (315) 552-6700

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

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227052800000",
    "number": "1164422366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2004",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574504",
            "telephone_number": "315-362-5285",
            "fax_number": "315-445-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 IRVING AVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101687",
            "telephone_number": "315-470-7551",
            "fax_number": "315-470-2719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAVALA",
        "first_name": "CARLA",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-29",
        "last_updated": "2008-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "010379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.