NPIMap

Individual provider Active NPI

Andrea M Dedona, PA

  • Physician Assistant
  • Queensbury, NY
National Provider Identifier
1225066053
Registry record updated Jan 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
008010 Issued in NY
Practice address
17 Main St
Queensbury, NY 12804-4007
Phone
(518) 798-0767
Fax
(518) 798-0815
NPI assigned
Jun 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2015

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 008010 NY Primary

Addresses

Primary practice location

17 Main St
Queensbury, NY 12804-4007

Mailing address

17 Main St
Queensbury, NY 12804-4007
Phone (518) 798-0767

Other identifiers 1

IdentifierTypeStateIssuer
02352436MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080813000766 NY Practitioner - Physician Assistant 3476628215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saratoga HospitalGroup PAC ID 6406740273, 353 clinicians

Practice addresses (Care Compare)

1 W Ave
Suite 300
Saratoga Springs, NY 12866-6050
Phone (518) 693-4699

211 Church St
Saratoga Springs, NY 12866-1003
Phone (518) 583-8421

Hospital & facility affiliations

  • Saratoga Hospital Hospital, Saratoga Springs, NY, CCN 330222
  • Glens Falls Hospital Hospital, Glens Falls, NY, CCN 330191

Merit-based Incentive Payment System (MIPS)

Final score
68.51 of 100Reported as group
Quality
56.19
Improvement activities
40
Cost
75.36

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Saratoga Hospital CurrentSince Jul 1, 2019 Accepting new patients
Saratoga Hospital CurrentSince Jul 1, 2019 Accepting new patients
Saratoga Hospital Past Accepting new patients

Locations

2388 Route 9
Mechanicville, NY 12118
Phone (518) 587-0845

1 West Ave
Ste 300
Saratoga Springs, NY 12866
Phone (518) 693-4699

3044 Route 50
Saratoga Springs, NY 12866
Phone (518) 886-5800

Interoperability endpoints

  • Direct secure messaging: adedona97592@albanymed.direct-ci.com

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.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422316800000",
    "number": "1225066053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 MAIN ST",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128044007",
            "telephone_number": "518-798-0767",
            "fax_number": "518-798-0815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 MAIN ST",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128044007",
            "telephone_number": "518-798-0767",
            "fax_number": "518-798-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDONA",
        "first_name": "ANDREA",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2015-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02352436",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Queensbury, NY

Sources for this page

Verify at the official NPI Registry.