Individual provider Active NPI

Peter R Iannotta, R.P.A.-C

  • Medical Physician Assistant
  • Cortland, NY
National Provider Identifier
1174680144
Registry record updated Apr 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
008103 Issued in NY
Practice address
11 Alvena Ave
Cortland, NY 13045-1150
Phone
(074) 285-7576
Fax
(607) 428-5759
NPI assigned
Jan 2, 2007
Last updated
Apr 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 008103 NY
Medical Physician Assistant 363AM0700X 008103 NY Primary

Addresses

Primary practice location

11 Alvena Ave
Cortland, NY 13045-1150

Mailing address

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address piannotta161657@direct-guthrie.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
008103NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Medical Practice, PC CurrentSince Jan 15, 2019 Accepting new patients

Locations

134 Homer Ave
Cortland, NY 13045
Phone (607) 756-3500

Interoperability endpoints

  • Direct secure messaging: piannotta161657@direct-guthrie.org
  • Direct secure messaging: piannotta161757@direct-guthrie.org

Organizations & group practices 1

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": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1174680144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858",
            "fax_number": "315-478-0840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 ALVENA AVE",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130451150",
            "telephone_number": "074-285-7576",
            "fax_number": "607-428-5759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IANNOTTA",
        "first_name": "PETER",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "R.P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008103",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "008103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "piannotta161657@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11 Alvena Ave",
            "city": "Cortland",
            "state": "NY",
            "country_code": "US",
            "postal_code": "130451150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cortland, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.