Individual provider Active NPI

Lydia Jayne Coyne, PA-C

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1386125037
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
02236-1 Issued in NY
Practice address
3800 W Genesee St
Syracuse, NY 13219-1928
Phone
(315) 552-9080
NPI assigned
Aug 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 02236-1 NY Primary

Addresses

Primary practice location

3800 W Genesee St
Syracuse, NY 13219-1928

Mailing address

7375 Oswego Rd
Liverpool, NY 13090-3717
Phone (315) 552-9080

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
I20181027000055 NY Practitioner - Physician Assistant 3779836416 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellnow Urgent Care, P.C.Group PAC ID 8325320864, 395 clinicians

Practice addresses (Care Compare)

1600 Erie Blvd E
Syracuse, NY 13210-1212
Phone (315) 401-3204

3800 W Genesee St
Syracuse, NY 13219-1928
Phone (315) 552-9080

514 S 2ND St
Fulton, NY 13069-2804
Phone (315) 552-9104

7375 Oswego Rd
Suite 1
Liverpool, NY 13090-3717
Phone (315) 291-0064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellnow Urgent Care, PC Past Accepting new patients

Organizations & group practices 2

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": "1534809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1386125037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7375 OSWEGO RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130903717",
            "telephone_number": "315-552-9080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 W GENESEE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132191928",
            "telephone_number": "315-552-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COYNE",
        "first_name": "LYDIA",
        "middle_name": "JAYNE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-21",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "02236-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.