Individual provider Active NPI

Laurie Conroe Mousaw, CNM

  • Advanced Practice Midwife
  • Potsdam, NY
National Provider Identifier
1194703744
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
F0009701 Issued in NY
Practice address
49 Lawrence Ave
Potsdam, NY 13676
Phone
(315) 261-2153
Fax
(315) 265-2540
NPI assigned
Jan 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X F0009701 NY Primary
Registered Nurse 163W00000X 349218 NY

Addresses

Primary practice location

49 Lawrence Ave
Potsdam, NY 13676

Mailing address

50 Leroy St
Potsdam, NY 13676-1786
Phone (315) 265-3300

Other identifiers 1

IdentifierTypeStateIssuer
02146830MedicaidNY

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060406000156 NY Practitioner - Certified Nurse Midwife (CNM) 9931118767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
98.56 of 100Reported as apm
Quality
87.76
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
349218NYMDFamily Nurse Practitioner
F0009701NYMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Jan 1, 2006 Accepting new patients
Canton-Potsdam Hospital CurrentSince Jan 1, 2006 Accepting new patients
Womens Room OBGYN PLLC Past Accepting new patients
Canton Potsdam Hospital Past Accepting new patients

Locations

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

49 Lawrence Ave
Potsdam, NY 13676
Phone (315) 261-5550

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

190 Outer Main St
Potsdam, NY 13676
Phone (315) 265-1095

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1194703744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 LEROY ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761786",
            "telephone_number": "315-265-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 LAWRENCE AVE",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "13676",
            "telephone_number": "315-261-2153",
            "fax_number": "315-265-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUSAW",
        "first_name": "LAURIE",
        "middle_name": "CONROE",
        "name_prefix": "Mrs.",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-04",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NY",
            "license": "F0009701",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "349218",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02146830",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Potsdam, NY

Sources for this page

Verify at the official NPI Registry.