Individual provider Active NPI

Kathryn E Palomino, MD

  • Pediatric Orthopaedic Surgery Physician
  • East Syracuse, NY
National Provider Identifier
1326043381
Registry record updated Nov 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X
License
222406 Issued in NY
Practice address
6620 Fly Road
Ste 200
East Syracuse, NY 13057
Phone
(315) 464-4472
NPI assigned
Jun 16, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 222406 NY
Pediatric Orthopaedic Surgery Physician 207XP3100X 222406 NY Primary

Addresses

Primary practice location

6620 Fly Road
Ste 200
East Syracuse, NY 13057

Mailing address

6620 Fly Road
Ste 200
East Syracuse, NY 13057
Phone (315) 464-4472

Other identifiers 1

IdentifierTypeStateIssuer
02183920MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100420000071 NY Practitioner - Orthopedic Surgery 6406982024 Reassigns benefits to 1 organization
I20220311002055 OR Practitioner - Orthopedic Surgery 6406982024 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
222406NYMDPediatric Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upstate Orthopedics, LLP Orthopaedic Surgery CurrentSince Sep 1, 2001 Accepting new patients
Upstate Orthopedics, LLP Orthopaedic Surgery CurrentSince Sep 1, 2001 Accepting new patients
Legacy Clinics LLC Orthopaedic Surgery CurrentSince Mar 2, 2022 Accepting new patients
Legacy Emanuel Hospital & Health Center Past Accepting new patients

Locations

208 Township Blvd
Ste 200
Camillus, NY 13031
Phone (315) 464-4472

6620 Fly Rd
Ste 200
East Syracuse, NY 13057
Phone (315) 464-4472

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

450 N Graham St
Portland, OR 97227
Phone (503) 413-4161

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

Organizations & group practices 4

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": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259539200000",
    "number": "1326043381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6620 FLY ROAD",
            "address_2": "STE 200",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "13057",
            "telephone_number": "315-464-4472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 FLY ROAD",
            "address_2": "STE 200",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "13057",
            "telephone_number": "315-464-4472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALOMINO",
        "first_name": "KATHRYN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-16",
        "last_updated": "2009-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "222406",
            "primary": false
        },
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "NY",
            "license": "222406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02183920",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Syracuse, NY

Sources for this page

Verify at the official NPI Registry.