Individual provider Active NPI

Patricia Stewart, NP

  • Family Nurse Practitioner
  • Liverpool, NY
National Provider Identifier
1346496296
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F338909 Issued in NY
Practice address
4811 Buckley Rd
Liverpool, NY 13088-3629
Phone
(315) 457-9966
Fax
(315) 457-9854
NPI assigned
Aug 12, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 568291 NY
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X F338909 NY Primary

Addresses

Primary practice location

4811 Buckley Rd
Liverpool, NY 13088-3629

Mailing address

4811 Buckley Rd
Liverpool, NY 13088-3629
Phone (315) 457-9966

Other identifiers 1

IdentifierTypeStateIssuer
03033878MedicaidNY

Other names 1

  • Miss Patricia Anderson Former name

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
I20210423001290 NY Practitioner - Nurse Practitioner 9234547605 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crouse Health Hospital IncGroup PAC ID 9739173774, 155 clinicians

Practice addresses (Care Compare)

736 Irving Ave
Syracuse, NY 13210-1602
Phone (315) 470-7111

Hospital & facility affiliations

  • Crouse Hospital Hospital, Syracuse, NY, CCN 330203

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
568291NYMDRegistered Nurse
338909NYMDLicensed Practical Nurse
F338909NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Crouse Health Hospital, Inc. CurrentSince Mar 29, 2021 Accepting new patients
Pathology Associates of Syracuse, PC Single Specialty Current Accepting new patients
Crouse Health Hospital Inc Single Specialty CurrentSince Mar 29, 2021 Accepting new patients

Locations

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1218499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1346496296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 BUCKLEY RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883629",
            "telephone_number": "315-457-9966",
            "fax_number": "315-457-9854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 BUCKLEY RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883629",
            "telephone_number": "315-457-9966",
            "fax_number": "315-457-9854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "PATRICIA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-12",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "568291",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F338909",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03033878",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "ANDERSON",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.