Individual provider Active NPI

Eleanor Jane Laclair, ANP

  • Adult Health Nurse Practitioner
  • Malone, NY
National Provider Identifier
1215186101
Registry record updated Apr 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
304996 Issued in NY
Practice address
133 Park St
Malone, NY 12953-1244
Phone
(518) 483-3000
NPI assigned
Sep 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 0024171721 VA
Adult Health Nurse Practitioner 363LA2200X 304996 NY Primary

Addresses

Primary practice location

133 Park St
Malone, NY 12953-1244

Mailing address

133 Park St
Malone, NY 12953-1244
Phone (518) 483-3000

Other practice location 1

16268 Bennett Road
Culpeper, VA 22701-3339
Phone (540) 825-6263

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
I20090729000532 NY Practitioner - Nurse Practitioner 2860545449 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alice Hyde Medical CenterGroup PAC ID 4082525837, 88 clinicians

Practice addresses (Care Compare)

133 Park St
Malone, NY 12953-1243
Phone (518) 481-2545

6087 State St
Suite 11
Chateaugay, NY 12920
Phone (518) 497-6622

969 State RT
Suite 11
Moira, NY 12957
Phone (518) 529-7847

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
304996NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alice Hyde Medical Center CurrentSince Mar 7, 2023 Accepting new patients
Alice Hyde Medical Center Current Accepting new patients
Alice Hyde Medical Center Past Accepting new patients

Locations

6087 State Route 11
Chateaugay, NY 12920
Phone (518) 481-8450

5 Clay St
Malone, NY 12953
Phone (518) 483-0705

969 State Route 11
Moira, NY 12957
Phone (518) 529-7847

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1221523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1215186101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 PARK ST",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129531244",
            "telephone_number": "518-483-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 PARK ST",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129531244",
            "telephone_number": "518-483-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16268 Bennett Road",
            "address_purpose": "LOCATION",
            "city": "Culpeper",
            "state": "VA",
            "postal_code": "227013339",
            "country_code": "US",
            "telephone_number": "540-825-6263",
            "fax_number": "540-825-4911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACLAIR",
        "first_name": "ELEANOR",
        "middle_name": "JANE",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-16",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024171721",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "304996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Malone, NY

Sources for this page

Verify at the official NPI Registry.