NPIMap

Organization Active NPI

Familycare Medical Group PC

  • Non-Pharmacy Dispensing Site
  • Syracuse, NY
National Provider Identifier
1225459175
Registry record updated Jan 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
203406 Issued in NY
Legal business name
FAMILYCARE MEDICAL GROUP PC
Practice address
182 Intrepid LN
Syracuse, NY 13205-2545
Phone
(315) 218-7020
NPI assigned
Dec 19, 2013
Organization subpart
Yes
Parent organization
MEDVANTXAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2017

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

Authorized official

Name
Scott Peterson
Title
Cfo
Phone
(858) 628-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 203406 NY Primary

Addresses

Primary practice location

182 Intrepid LN
Syracuse, NY 13205-2545

Mailing address

9276 Scranton Rd
Suite 100
San Diego, CA 92121-7701

Other names 1

  • Brighton Medical Associates Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0713543Brighton Medical Associates182 Intrepid Lane, Syracuse, NY 13205Provider-performed microscopyMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Familycare Medical Grou6 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

182 Intrepid Ln
Syracuse, NY 13205
Phone (315) 218-7020

NPI Registry JSON

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

{
    "created_epoch": "1387411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1225459175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9276 SCRANTON RD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921217701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 INTREPID LN",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132052545",
            "telephone_number": "315-218-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILYCARE MEDICAL GROUP PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX",
        "enumeration_date": "2013-12-19",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "858-628-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NY",
            "license": "203406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brighton Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.