Individual provider Active NPI

Shannon K Birmingham, PSY D

  • Psychologist
  • Wampsville, NY
National Provider Identifier
1336428259
Registry record updated Aug 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
138 North Court Street
Wampsville, NY 13163-0608
Phone
(315) 366-2327
Fax
(315) 366-2599
NPI assigned
Aug 9, 2011
Last updated
Aug 9, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary

Addresses

Primary practice location

138 North Court Street
Wampsville, NY 13163-0608

Mailing address

138 North Court Street
Wampsville, NY 13163-0608
Phone (315) 366-2327

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140722001646 NY Practitioner - Clinical Psychologist 5395961668 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3300 James St
Suite 100
Syracuse, NY 13206-2392
Phone (315) 422-0300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
020596NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatry Services of New York PC CurrentSince Feb 20, 2024 Accepting new patients
Psychiatry Services of New York, P.C. CurrentSince Feb 20, 2024 Accepting new patients
Psychological Healthcare, PLLC CurrentSince Jul 1, 2015 Accepting new patients

Locations

8289 Loop Rd
Baldwinsville, NY 13027
Phone (315) 452-0300

890 7th North St
Ste 100
Liverpool, NY 13088

890 7th North St
Ste 200
Liverpool, NY 13088
Phone (315) 200-1056

890 7th North St
Ste 200100
Liverpool, NY 13088

3300 James St
Ste 100
Syracuse, NY 13206
Phone (315) 671-2202

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/28623/brand/6/csg/1/fhir/r4
  • Direct secure messaging: shannon.birmingham.1@28623.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312848000000",
    "number": "1336428259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 NORTH COURT STREET",
            "city": "WAMPSVILLE",
            "state": "NY",
            "postal_code": "131630608",
            "telephone_number": "315-366-2327",
            "fax_number": "315-366-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 NORTH COURT STREET",
            "city": "WAMPSVILLE",
            "state": "NY",
            "postal_code": "131630608",
            "telephone_number": "315-366-2327",
            "fax_number": "315-366-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIRMINGHAM",
        "first_name": "SHANNON",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PSY D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-09",
        "last_updated": "2011-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wampsville, NY

Sources for this page

Verify at the official NPI Registry.