Individual provider Active NPI

William Paul Hannan, MD

  • Pediatric Rheumatology Physician
  • Syracuse, NY
National Provider Identifier
1265450498
Registry record updated Aug 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Rheumatology PhysicianTaxonomy code 2080P0216X
License
159129 Issued in NY
Practice address
750 E Adams St
Syracuse, NY 13210-2342
Phone
(315) 464-5450
Fax
(315) 464-5853
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 159129 NY
Pediatric Rheumatology Physician 2080P0216X 159129 NY Primary

Addresses

Primary practice location

750 E Adams St
Syracuse, NY 13210-2342

Mailing address

750 E Adams St
Syracuse, NY 13210-2342
Phone (315) 464-5450

Other identifiers 1

IdentifierTypeStateIssuer
00903282MedicaidNY

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060201000120 NY Practitioner - RheumatologyPractitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists) 8820002629 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Service Group CurrentSince Oct 1, 2002 Accepting new patients

Locations

725 Irving Ave
Fl 8
Syracuse, NY 13210
Phone (315) 464-7611

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

Interoperability endpoints

  • Direct secure messaging: whannan5972@direct.upstate.edu

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407888000000",
    "number": "1265450498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-5450",
            "fax_number": "315-464-5853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-5450",
            "fax_number": "315-464-5853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNAN",
        "first_name": "WILLIAM",
        "middle_name": "PAUL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2014-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NY",
            "license": "159129",
            "primary": false
        },
        {
            "code": "2080P0216X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Rheumatology",
            "state": "NY",
            "license": "159129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00903282",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.