Individual provider Active NPI

Emily Glisson, NP

  • Nurse Practitioner
  • Cicero, NY
National Provider Identifier
1164837589
Registry record updated Nov 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
338789 Issued in NY
Practice address
8393 Elta Drive
Cicero, NY 13039-8714
Phone
(315) 698-0290
Fax
(315) 698-0291
NPI assigned
Jun 24, 2014
Last updated
Nov 7, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 338789 NY Primary

Addresses

Primary practice location

8393 Elta Drive
Cicero, NY 13039-8714

Mailing address

8393 Elta Drive
Cicero, NY 13039-8714
Phone (315) 698-0290

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
I20140812001018 NY Practitioner - Nurse Practitioner 6406073675 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians
St Josephs Hospital Health CenterGroup PAC ID 9234043324, 107 clinicians

Practice addresses (Care Compare)

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

5100 W Taft Rd
Liverpool, NY 13088-4841

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
338789NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Pathology, PC Current Accepting new patients
St Josephs Hospital Health Center CurrentSince Jan 2, 2018 Accepting new patients
St Joseph's Hospital Health Center CurrentSince Jan 2, 2018 Accepting new patients
St Josephs Medical PC CurrentSince Oct 1, 2025 Accepting new patients
North Medical PC Current Accepting new patients

Locations

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

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

301 Prospect Ave
Ste 706
Syracuse, NY 13203
Phone (315) 703-5200

Interoperability endpoints

  • Direct secure messaging: eglisson84947@direct.trinity-health.org

Organizations & group practices 5

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.

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": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415318400000",
    "number": "1164837589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8393 ELTA DRIVE",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130398714",
            "telephone_number": "315-698-0290",
            "fax_number": "315-698-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8393 ELTA DRIVE",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130398714",
            "telephone_number": "315-698-0290",
            "fax_number": "315-698-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLISSON",
        "first_name": "EMILY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-24",
        "last_updated": "2014-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "338789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cicero, NY

Sources for this page

Verify at the official NPI Registry.