Individual provider Active NPI

Gillian Dibich, PA

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1215512876
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
034823 Issued in NY
Practice address
90 Presidential Plaza
Syracuse, NY 13202
Phone
(315) 464-3833
Fax
(315) 464-3791
NPI assigned
Mar 16, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 034823 NY Primary

Addresses

Primary practice location

90 Presidential Plaza
Syracuse, NY 13202

Mailing address

251 Salina Meadows Parkway
Suite 100
Syracuse, NY 13212
Phone (315) 464-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250616001939 OR Practitioner - Physician Assistant 0244741395 Reassigns benefits to 1 organization
I20260219000325 NY Practitioner - Physician Assistant 0244741395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Columbia Lutheran CharitiesGroup PAC ID 5294643359, shared by 8 NPIs, 110 clinicians

Practice addresses (Care Compare)

1639 SE Ensign LN
Warrenton, OR 97146-7308
Phone (503) 338-4500

90 Presidential PLZ
Syracuse, NY 13202-2240
Phone (315) 464-8093

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
034823NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Lutheran Charities CurrentSince Jun 30, 2025 Accepting new patients
Columbia Lutheran Charities CurrentSince Jun 30, 2025 Accepting new patients
Suny Health Science Center at Syracuse Physician Assistant CurrentSince Dec 31, 2025 Accepting new patients
Suny Health Science Center at Syracuse CurrentSince Dec 31, 2025 Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients
Columbia Lutheran Charities Past Accepting new patients

Locations

90 Presidential Plz
Syracuse, NY 13202
Phone (315) 464-3836

251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212
Phone (315) 464-2000

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

2111 Exchange St
Astoria, OR 97103
Phone (503) 325-4321

2265 Exchange St
Fl First
Astoria, OR 97103

1639 SE Ensign Ln
Ste B103
Warrenton, OR 97146
Phone (503) 338-4500

Organizations & group practices 7

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 6

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": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1215512876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 SALINA MEADOWS PARKWAY",
            "address_2": "SUITE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13212",
            "telephone_number": "315-464-2000",
            "fax_number": "315-464-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 PRESIDENTIAL PLAZA",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13202",
            "telephone_number": "315-464-3833",
            "fax_number": "315-464-3791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBICH",
        "first_name": "GILLIAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-16",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "034823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.