Upstate Gastroenterology, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

111362 Issued in NY

Legal business name

UPSTATE GASTROENTEROLOGY, LLC

Practice address

1000 E Genesee St
Suite 206
Syracuse, NY 13210-1892

Phone

(315) 464-1616

Fax

(315) 464-1617

NPI assigned

Aug 13, 2012

Organization subpart

No

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

Authorized official

Name

Michael C. Iannuzzi, MDNPI 1376575597

Title

MD

Phone

(315) 464-3835

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Listed as

Upstate Gastroenterology LLCCCN 33C0001129

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael C Iannuzzi, MD

  • Pulmonary Disease Physician
  • Syracuse, NY
  • NPI 1376575597
  NPD (past) Authorized official

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1366799033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E GENESEE ST",
            "address_2": "SUITE 206",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101892",
            "telephone_number": "315-464-1616",
            "fax_number": "315-464-1617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E GENESEE ST",
            "address_2": "SUITE 206",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101892",
            "telephone_number": "315-464-1616",
            "fax_number": "315-464-1617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE GASTROENTEROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-13",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "IANNUZZI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "315-464-3835",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NY",
            "license": "111362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03747028",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Upah
• Updesign Primary Care, LLC
• Upstate Community Medical, PC
• Upstate Emergency Medicine, Inc
• Upstate Family and Preventive Medicine, Inc
• Upstate Medical Anesthesiology Group, Inc.
• Upstate Medical Center
• Upstate Medical Professionals, PC
• Upstate Medical University
• Upstate Medical University

• All providers in Syracuse, NY
• Ambulatory Surgical Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.