Individual provider Active NPI

Loretta Lynne Edinger, NP

  • Family Nurse Practitioner
  • Tully, NY
National Provider Identifier
1235425372
Registry record updated Jan 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
336816 Issued in NY
Practice address
5-7 State Street
Tully, NY 13159-3218
Phone
(315) 696-4635
NPI assigned
Jun 28, 2011
Last updated
Jan 16, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 336816 NY Primary

Addresses

Primary practice location

5-7 State Street
Tully, NY 13159-3218

Mailing address

1001 W Fayette St
Suite 400
Syracuse, NY 13204-2856
Phone (315) 472-1488

Other identifiers 1

IdentifierTypeStateIssuer
03349997MedicaidNY

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
I20110915000115 NY Practitioner - Nurse Practitioner 1355512757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
May accept Medicare assignment
Group practices
Familycare Medical Group PCGroup PAC ID 5193639565, 110 clinicians
Select PT, OT and SLP Rehabilitation Ny, PLLCGroup PAC ID 3870986656, 261 clinicians

Practice addresses (Care Compare)

1001 W Fayette St
Suite 400
Syracuse, NY 13204-2866
Phone (315) 472-1488

125 Harry Howard Ave
Hudson, NY 12534-1601
Phone (800) 479-7695

57 State St
Tully, NY 13159-3218
Phone (315) 696-4635

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
336816NYMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Familycare Medical Group, PC CurrentSince Aug 15, 2011 Accepting new patients
Your Health Your Choice Dietetics and Nutrition PLLC Past Accepting new patients

Locations

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

Interoperability endpoints

  • Direct secure messaging: ledinger@fcmg.medentdirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358294400000",
    "number": "1235425372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST",
            "address_2": "SUITE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042856",
            "telephone_number": "315-472-1488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5-7 STATE STREET",
            "city": "TULLY",
            "state": "NY",
            "postal_code": "131593218",
            "telephone_number": "315-696-4635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDINGER",
        "first_name": "LORETTA",
        "middle_name": "LYNNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2013-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "336816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03349997",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tully, NY

Sources for this page

Verify at the official NPI Registry.