Individual provider Active NPI

Lisa Simonetta Snyder, RN,MSN,FNP-C

  • Adult Medicine Physician
  • Cortland, NY
National Provider Identifier
1265423743
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
F3322590 Issued in NY
Practice address
134 Homer Ave
Cortland, NY 13045-1206
Phone
(607) 756-3561
Fax
(607) 428-5142
NPI assigned
Nov 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X F3322590 NY Primary

Addresses

Primary practice location

134 Homer Ave
Cortland, NY 13045-1206

Mailing address

134 Homer Ave
PO Box 628
Cortland, NY 13045-1206
Phone (607) 756-3561

Other identifiers 1

IdentifierTypeStateIssuer
02057216MedicaidNY

Other names 1

  • Lisa Simonetta Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lsnyder161666@direct-guthrie.org Direct

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
I20071127000079 NY Practitioner - Nurse Practitioner 0840388906 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Guthrie Medical Group PCGroup PAC ID 6002728656, 795 clinicians

Practice addresses (Care Compare)

134 Homer Ave
Cortland, NY 13045-1206
Phone (607) 756-3500

Hospital & facility affiliations

  • Guthrie Cortland Regional Medical Center Hospital, Cortland, NY, CCN 330175
  • Cayuga Medical Center at Ithaca Hospital, Ithaca, NY, CCN 330307

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
F3322590NYMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Guthrie Medical Group, P.C. CurrentSince Oct 3, 2020 Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Oct 3, 2020 Accepting new patients
Guthrie Medical Group PC Past Accepting new patients

Locations

130 Center Way
Corning, NY 14830
Phone (607) 936-9971

134 Homer Ave
Cortland, NY 13045
Phone (607) 756-3500

Interoperability endpoints

  • Direct secure messaging: lsnyder161666@direct-guthrie.org

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 2

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1265423743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 HOMER AVE",
            "address_2": "PO BOX 628",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130451206",
            "telephone_number": "607-756-3561",
            "fax_number": "607-428-5142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 HOMER AVE",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130451206",
            "telephone_number": "607-756-3561",
            "fax_number": "607-428-5142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNYDER",
        "first_name": "LISA",
        "middle_name": "SIMONETTA",
        "credential": "RN,MSN,FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NY",
            "license": "F3322590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02057216",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lsnyder161666@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "134 Homer Ave",
            "city": "Cortland",
            "state": "NY",
            "country_code": "US",
            "postal_code": "130451206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "SIMONETTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cortland, NY

Sources for this page

Verify at the official NPI Registry.