Individual provider Active NPI

Kirsten L Gruis, MD

  • Neuromuscular Medicine (Psychiatry & Neurology) Physician
  • Syracuse, NY
National Provider Identifier
1225127194
Registry record updated Dec 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuromuscular Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084N0008X
License
263856 Issued in NY
Practice address
90 Presidential PLZ
4TH Floor - Neurology
Syracuse, NY 13202-2240
Phone
(315) 464-4243
Fax
(315) 464-5350
NPI assigned
Oct 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromuscular Medicine (Psychiatry & Neurology) Physician 2084N0008X 263856 NY Primary
Neurology Physician 2084N0400X 263856 NY

Addresses

Primary practice location

90 Presidential PLZ
4TH Floor - Neurology
Syracuse, NY 13202-2240

Mailing address

90 Presidential PLZ
4TH Floor - Neurology
Syracuse, NY 13202-2240
Phone (315) 464-4243

Other identifiers 1

IdentifierTypeStateIssuer
03423003MedicaidNY

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
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355356800000",
    "number": "1225127194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 PRESIDENTIAL PLZ",
            "address_2": "4TH FLOOR - NEUROLOGY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132022240",
            "telephone_number": "315-464-4243",
            "fax_number": "315-464-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 PRESIDENTIAL PLZ",
            "address_2": "4TH FLOOR - NEUROLOGY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132022240",
            "telephone_number": "315-464-4243",
            "fax_number": "315-464-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUIS",
        "first_name": "KIRSTEN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2012-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0008X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neuromuscular Medicine",
            "state": "NY",
            "license": "263856",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "263856",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03423003",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.