Faxton St Lukes Healthcare

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

3203003H Issued in NY

Legal business name

FAXTON ST LUKES HEALTHCARE

Practice address

221 Broad St.
Oneida, NY 13421

Phone

(315) 366-0360

Fax

(315) 624-5152

NPI assigned

Oct 10, 2006

Organization subpart

Yes

Parent organization

FAXTON ST LUKES HEALTHCAREAs reported in NPPES

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

Authorized official

Name

Cody White

Title

Director of Revenue Cycle

Phone

(315) 801-4429

Specialties & licenses 1

Addresses

Electronic endpoints 1

Part of

MVHS Inc

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1336236249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 GENESEE STREET",
            "address_2": "BUSINESS OFFICE ROOM 315",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "13501",
            "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": "221 BROAD ST.",
            "city": "ONEIDA",
            "state": "NY",
            "postal_code": "13421",
            "telephone_number": "315-366-0360",
            "fax_number": "315-624-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAXTON ST LUKES HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAXTON ST LUKES HEALTHCARE",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "CODY",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "315-801-4429"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "3203003H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristie Evangelow, LMHC
• Tiffany Grace Evans, PHARM D
• Family Support in Central New York, Inc.
• Tammy Farr, FNP-BC
• Regina Farrell, MD
• Faxton St Lukes Healthcare
• Anita Fellows, LCSW
• Alyssa Fernandez, MSW
• Cassandra Casabonne Fisher
• Peter Daniel Fleming, PA-C

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Oneida, NY
• Providers in Oneida, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.