Individual provider Active NPI

Sarah Jane Tyner, MSN, RN, NNP

  • Neonatal Nurse Practitioner
  • Baldwinsville, NY
National Provider Identifier
1174075774
Registry record updated Dec 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
35-350409 Issued in NY
Practice address
7675 Poplar Field Cir
Baldwinsville, NY 13027-9350
Phone
(305) 915-5133
Fax
(315) 638-6240
NPI assigned
Oct 30, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X 35-350409 NY Primary
Nurse Practitioner 363L00000X 350409 NY

Addresses

Primary practice location

7675 Poplar Field Cir
Baldwinsville, NY 13027-9350

Mailing address

7675 Poplar Field Cir
Baldwinsville, NY 13027-9350
Phone (305) 915-5133

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
I20170112000005 NY Practitioner - Nurse Practitioner 5890076566 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
350409NYMDNurse Practitioner
35-350409NYMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph'S Physician Health, P.C. CurrentSince Jan 3, 2017 Accepting new patients
St. Peter'S Hospital of the City of Albany Nurse Practitioner CurrentSince Oct 1, 2023 Accepting new patients
St Josephs Medical PC CurrentSince Jul 7, 2018 Accepting new patients
St. Peter'S Hospital of the City of Albany Nurse Practitioner CurrentSince Oct 1, 2023 Accepting new patients
Oswego Hospital Past Accepting new patients

Locations

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

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

104 Union Ave
Syracuse, NY 13203
Phone (315) 422-4442

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

Interoperability endpoints

  • Direct secure messaging: styner2387773@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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1477785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481500800000",
    "number": "1174075774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7675 POPLAR FIELD CIR",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130279350",
            "telephone_number": "305-915-5133",
            "fax_number": "315-638-6240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7675 POPLAR FIELD CIR",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130279350",
            "telephone_number": "305-915-5133",
            "fax_number": "315-638-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYNER",
        "first_name": "SARAH",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "MSN, RN, NNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-30",
        "last_updated": "2016-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "NY",
            "license": "35-350409",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "350409",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baldwinsville, NY

Sources for this page

Verify at the official NPI Registry.