Individual provider Active NPI

Madalyn Mae Dillabough, PA

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1245961119
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
90 Presidential PLZ
Syracuse, NY 13202-2240
Phone
(315) 464-9335
NPI assigned
Jun 22, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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 Primary

Addresses

Primary practice location

90 Presidential PLZ
Syracuse, NY 13202-2240

Mailing address

1 Linden St
Massena, NY 13662-2552
Phone (315) 212-1273

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
I20221205001054 NY Practitioner - Physician Assistant 7719356385 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
State University of Ny Upstate Medical University, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

4101 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 637-7878

4103 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 744-1500

4117 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 744-1551

5100 W Taft Rd
Liverpool, NY 13088-4841

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.56 of 100Reported as group
Quality
71.97
Promoting interoperability
100
Improvement activities
40
Cost
75.04

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Medical PC Current Accepting new patients
Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in CurrentSince Nov 18, 2022 Accepting new patients

Locations

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

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

90 Presidential Plz
Syracuse, NY 13202
Phone (315) 464-3836

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 and National Provider Directory roles.

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": "1655856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1245961119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LINDEN ST",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136622552",
            "telephone_number": "315-212-1273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 PRESIDENTIAL PLZ",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132022240",
            "telephone_number": "315-464-9335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLABOUGH",
        "first_name": "MADALYN",
        "middle_name": "MAE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-22",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.