Individual provider Active NPI

Kyle Groshans, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1336751627
Registry record updated Jan 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
403120-01 Issued in NY
Practice address
614 S Salina St Ste 300
Syracuse, NY 13202-3520
Phone
(315) 425-0599
Fax
(315) 471-6760
NPI assigned
Aug 19, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 403120-01 NY Primary

Addresses

Primary practice location

614 S Salina St Ste 300
Syracuse, NY 13202-3520

Mailing address

614 S Salina St Ste 300
Syracuse, NY 13202-3520
Phone (315) 425-0599

Other practice location 1

8366 Craine Dr
Manlius, NY 13104-9422
Phone (631) 275-3531

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
I20221108002973 NY Practitioner - Nurse Practitioner 1254708076 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychiatry Faculty Practice, IncGroup PAC ID 9234458530, 90 clinicians

Practice addresses (Care Compare)

713 Harrison St
BLDG 3
Syracuse, NY 13210-2305
Phone (315) 464-3265

719 Harrison St
Syracuse, NY 13210-2305

Merit-based Incentive Payment System (MIPS)

Final score
94.28 of 100Reported as group
Quality
88.2
Promoting interoperability
100
Improvement activities
40
Cost
69.72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
403120-01NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Psychiatry Faculty Practice, Inc. CurrentSince Nov 1, 2022 Accepting new patients

Locations

719 Harrison St
Syracuse, NY 13210
Phone (315) 464-3265

713 Harrison St
Bldg 3
Syracuse, NY 13210
Phone (315) 464-3265

Interoperability endpoints

  • Direct secure messaging: kgroshans26986@direct.upstate.edu

Organizations & group practices 1

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": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610755200000",
    "number": "1336751627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 S SALINA ST STE 300",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023520",
            "telephone_number": "315-425-0599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 S SALINA ST STE 300",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023520",
            "telephone_number": "315-425-0599",
            "fax_number": "315-471-6760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8366 Craine Dr",
            "address_purpose": "LOCATION",
            "city": "Manlius",
            "state": "NY",
            "postal_code": "131049422",
            "country_code": "US",
            "telephone_number": "631-275-3531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROSHANS",
        "first_name": "KYLE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-19",
        "last_updated": "2021-01-16",
        "certification_date": "2021-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403120-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.