Individual provider Active NPI

Kevin T Le Roy, CFNP

  • Nurse Practitioner
  • Oswego, NY
National Provider Identifier
1316175052
Registry record updated Apr 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
335967 Issued in NY
Practice address
110 W 6TH St
Oswego, NY 13126-2507
Phone
(315) 349-5511
Fax
(315) 349-5732
NPI assigned
Jul 1, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 335967 NY
Nurse Practitioner 363L00000X 335967 NY Primary

Addresses

Primary practice location

110 W 6TH St
Oswego, NY 13126-2507

Mailing address

5100 W Taft Rd
Suite 1C
Liverpool, NY 13088-3807
Phone (315) 452-2333

Other identifiers 1

IdentifierTypeStateIssuer
03133180MedicaidNY

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
I20090826000553 NY Practitioner - Nurse Practitioner 5890840979 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St Josephs Medical PC Emergency Medicine CurrentSince Jan 2, 2018 Accepting new patients
St. Joseph'S Physician Health, P.C. CurrentSince Jan 2, 2018 Accepting new patients
Port City Emergency Physicians LLP Emergency Medicine CurrentSince Jan 1, 2015 Accepting new patients
Port City Emergency Physicians LLP Emergency Medicine Current Accepting new patients
North Medical PC Emergency Medicine Current Accepting new patients
Oswego Hospital CurrentSince Aug 1, 2019 Accepting new patients

Locations

75 Remit Dr
Chicago, IL 60675

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

5100 W Taft Rd
Ste 1C
Liverpool, NY 13088
Phone (315) 452-2333

110 W 6th St
Oswego, NY 13126
Phone (315) 349-5511

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

104 Union Ave
Syracuse, NY 13203
Phone (315) 422-4442

Interoperability endpoints

  • Direct secure messaging: kleroy@oswegohealth.hiemail.healtheconnections.org

Organizations & group practices 6

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": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333929600000",
    "number": "1316175052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD",
            "address_2": "SUITE 1C",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883807",
            "telephone_number": "315-452-2333",
            "fax_number": "315-452-2336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W 6TH ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131262507",
            "telephone_number": "315-349-5511",
            "fax_number": "315-349-5732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE ROY",
        "first_name": "KEVIN",
        "middle_name": "T",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-01",
        "last_updated": "2012-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "335967",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "335967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03133180",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oswego, NY

Sources for this page

Verify at the official NPI Registry.