Individual provider Active NPI

Trent Peppard, DO

  • Emergency Medicine Physician
  • Syracuse, NY
National Provider Identifier
1174789978
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
34.010056 Issued in OH
Practice address
750 East Adams St
Syracuse, NY 13210-2306
Phone
(315) 464-4363
Fax
(315) 464-8690
NPI assigned
Jul 31, 2008
Last updated
Jun 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 329935 NY
Emergency Medicine Physician 207P00000X 34.010056 OH Primary

Addresses

Primary practice location

750 East Adams St
Syracuse, NY 13210-2306

Mailing address

750 East Adams St
Syracuse, NY 13210-2306
Phone (315) 464-4363

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240611004521 NY Practitioner - Emergency Medicine 1850576463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of New England, College of Osteo Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upstate Emergency Medicine, IncGroup PAC ID 2466443494, 60 clinicians

Practice addresses (Care Compare)

750 E Adams St
Syracuse, NY 13210-2342
Phone (315) 464-4363

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.37 of 100Reported as group
Quality
86.1
Promoting interoperability
100
Improvement activities
40
Cost
70.12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34.010056OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upstate Emergency Medicine, Inc Emergency Medicine CurrentSince Jul 1, 2024 Accepting new patients
Tree Grove Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Harrison Lake Emergency Physicians Emergency Medicine Past Accepting new patients
Lucas County Emergency Physicians Inc Emergency Medicine Past Accepting new patients

Locations

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

Interoperability endpoints

  • Direct secure messaging: tpeppard156358@direct.upstate.edu

Organizations & group practices 4

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": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1174789978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 EAST ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-4363",
            "fax_number": "315-464-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 EAST ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-4363",
            "fax_number": "315-464-8690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEPPARD",
        "first_name": "TRENT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-31",
        "last_updated": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "329935",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34.010056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.