Active NPI
Maynard A. Shumway, PA-C
- Surgical Physician Assistant
- Utica, NY
National Provider Identifier
1205860798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 001412
- Practice address
- 110 Lomond CT
Utica, NY 13502-5950 - Phone
- (315) 292-1264
- Fax
- (315) 266-0385
- NPI assigned
- Jul 10, 2006
- Last updated
- Jul 23, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 001412 | NY | Primary |
Addresses
Primary practice location
110 Lomond CT
Utica, NY 13502-5950
Mailing address
601 Gates Rd
Ste 3
Vestal, NY 13850
Phone (607) 584-7385
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03324334 | Medicaid | NY |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1412 | NY | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adirondack Pain Management, PLLC | Past | Accepting new patients | |
| Atlantic Physician Services of Maryland, PC | Past | Accepting new patients | |
| Upstate Pain Medicine PC | Past | Accepting new patients | |
| M R Goriganti Physician PLLC | Past | Accepting new patients |
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.
-
- Pain Medicine (Anesthesiology) Physician
- Utica, NY
- NPI 1104899756
-
- Physical Medicine & Rehabilitation Physician
- Syracuse, NY
- NPI 1508049032
-
- Specialist
- Fulton, NY
- NPI 1255498424
-
- Physician Assistant
- Baltimore, MD
- NPI 1174632376
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406073600000",
"number": "1205860798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 GATES RD",
"address_2": "STE 3",
"city": "VESTAL",
"state": "NY",
"postal_code": "13850",
"telephone_number": "607-584-7385",
"fax_number": "607-772-1223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LOMOND CT",
"city": "UTICA",
"state": "NY",
"postal_code": "135025950",
"telephone_number": "315-292-1264",
"fax_number": "315-266-0385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUMWAY",
"first_name": "MAYNARD",
"middle_name": "A.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2014-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NY",
"license": "001412",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03324334",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Utica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.