Individual provider Active NPI

Joseph A Coffey, PA

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1245319730
Registry record updated Oct 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
016070 Issued in NY
Practice address
5719 Widewaters Pkwy
Syracuse, NY 13214-1985
Phone
(315) 251-3100
Fax
(315) 449-9923
NPI assigned
Nov 3, 2006
Last updated
Oct 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X P-T0616 AR
Physician Assistant 363A00000X 016070 NY Primary

Addresses

Primary practice location

5719 Widewaters Pkwy
Syracuse, NY 13214-1985

Mailing address

5824 Widewaters Pkwy
East Syracuse, NY 13057-3072
Phone (315) 251-3100

Other identifiers 3

IdentifierTypeStateIssuer
1881663078OtherARNPI PROVIDER NUMBER PHY ASST LINK TO
DA7424OtherARPALMETTO MEDICARE RAILROAD
P-T0616OtherARLICENSE

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
I20121031000513 NY Practitioner - Physician Assistant 2466555123 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Alabama School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

301 Prospect Ave
Syracuse, NY 13203-1807
Phone (315) 448-5111

415 E 37TH St
Apt 21a
New York, NY 10016-3243
Phone (313) 525-1310

5719 Widewaters Pkwy
Syracuse, NY 13214-1985
Phone (315) 251-3100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
016070NYMDSpeech-Language Pathologist
P-T0616ARMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Syracuse Orthopedic Specialists, PLLC CurrentSince Oct 10, 2012 Accepting new patients
North Medical PC Current Accepting new patients
Russell B Allison PastSince Jan 1, 1990 Accepting new patients
Russell B Allison MD PA PastSince Jan 1, 1990 Accepting new patients

Locations

5824 Widewaters Pkwy
East Syracuse, NY 13057
Phone (315) 251-3105

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

5719 Widewaters Pkwy
Syracuse, NY 13214
Phone (315) 251-3110

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

Organizations & group practices 5

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 1

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": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349222400000",
    "number": "1245319730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5824 WIDEWATERS PKWY",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130573072",
            "telephone_number": "315-251-3100",
            "fax_number": "315-449-9923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5719 WIDEWATERS PKWY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141985",
            "telephone_number": "315-251-3100",
            "fax_number": "315-449-9923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COFFEY",
        "first_name": "JOSEPH",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2012-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "P-T0616",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI PROVIDER NUMBER PHY ASST LINK TO",
            "identifier": "1881663078",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO MEDICARE RAILROAD",
            "identifier": "DA7424",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "P-T0616",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.