Organization Active NPI

Women's Wellness Place, PC

  • Obstetrics & Gynecology Physician
  • Syracuse, NY
National Provider Identifier
1376617480
Registry record updated Feb 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
WOMEN'S WELLNESS PLACE, PC
Practice address
739 Irving Ave
Suite 300
Syracuse, NY 13210-1640
Phone
(315) 478-1158
Fax
(315) 478-3014
NPI assigned
Nov 20, 2006
Last updated
Feb 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2013

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

Authorized official

Name
Dr. Chantell Dalpe-Fung, MDNPI 1871544643
Title
Physician
Phone
(315) 478-1158

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

739 Irving Ave
Suite 300
Syracuse, NY 13210-1640

Mailing address

739 Irving Ave
Suite 300
Syracuse, NY 13210-1640
Phone (315) 478-1158

Other identifiers 1

IdentifierTypeStateIssuer
02375359MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050317000891 NY Part B Supplier - Clinic/Group Practice 8426003864 Receives reassigned benefits from 6 practitioners
Practice locations: Syracuse, NY

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0906328Women's Wellness Place PC739 Irving Avenue Suite 530, Syracuse, NY 13210ComplianceApr 1, 2027

National Provider Directory

National Provider Directory

Locations

5700 W Genesee St
Ste 221
Camillus, NY 13031
Phone (315) 631-3668

739 Irving Ave
Ste 300
Syracuse, NY 13210
Phone (315) 475-8599

739 Irving Ave
Ste 530
Syracuse, NY 13210
Phone (315) 478-1158

739 Irving Ave
Ste 640
Syracuse, NY 13210
Phone (315) 303-5659

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8865/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361145600000",
    "number": "1376617480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE",
            "address_2": "SUITE 300",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101640",
            "telephone_number": "315-478-1158",
            "fax_number": "315-478-3014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE",
            "address_2": "SUITE 300",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101640",
            "telephone_number": "315-478-1158",
            "fax_number": "315-478-3014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOMEN'S WELLNESS PLACE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2013-02-18",
        "status": "A",
        "authorized_official_last_name": "DALPE-FUNG",
        "authorized_official_first_name": "CHANTELL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "315-478-1158",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02375359",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2013; 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.