Marshall E Pedersen, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

126996 Issued in NY

Practice address

1656 Champlin Ave
Utica, NY 13502-4830

Phone

(315) 624-6000

Fax

(315) 801-8391

NPI assigned

Apr 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpedersen260483@direct.myadvocateaurora.org

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.

• MVHS Inc

  • Family Medicine Physician
  • Utica, NY
  • NPI 1770690737
  Medicare reassignment NPD
• MVHS Inc

  • Community/Retail Pharmacy
  • Utica, NY
  • NPI 1306573753
  NPD

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493337600000",
    "number": "1295799781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 GENESEE ST",
            "address_2": "BUSINESS OFFICE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135015930",
            "telephone_number": "315-801-3282",
            "fax_number": "315-801-8391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1656 CHAMPLIN AVE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135024830",
            "telephone_number": "315-624-6000",
            "fax_number": "315-801-8391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "MARSHALL",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2017-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NY",
            "license": "126996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02650237",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa J Pavlicek
• Jeannette Pavlus, LMSW
• Jenna Pawloski, FNP-C
• Jeffrey Allan Peck, D.D.S
• Faith Nicole Peckham
• Kathryn Marie Pedone, CF-SLP, M.S., TSSLD
• Andrew T Pellecchia, MD
• Barbara A Pellegrino, MSED
• Michael Pelton, LDO
• Jeana F Penree, LCSW-R

• Neurological Surgery Physician in Utica, NY
• Providers in Utica, NY by specialty
• Neurological Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.