Individual provider Active NPI

Misty Putnam, PA-C

  • Physician Assistant
  • Rochester, NY
National Provider Identifier
1396381000
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
024436 Issued in NY
Practice address
2021 Winton Rd S
Rochester, NY 14618-3998
Phone
(585) 427-7760
NPI assigned
Nov 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 024436 NY Primary
Hematology & Oncology Physician 207RH0003X 24436 NY

Addresses

Primary practice location

2021 Winton Rd S
Rochester, NY 14618-3998

Mailing address

110 W 6TH St
Oswego, NY 13126-2598

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
I20200108002102 NY Practitioner - Physician Assistant 1951736578 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

15 Canandaigua St
Shortsville, NY 14548-9763
Phone (585) 289-3560

350 Parrish St
Canandaigua, NY 14424-1731
Phone (585) 396-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as group
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24436NYMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Frederick Ferris Thompson Hospital CurrentSince Jul 19, 2021 Accepting new patients

Locations

73 Buffalo St
Ste 100
Canandaigua, NY 14424

15 Canandaigua St
Shortsville, NY 14548
Phone (585) 289-3560

Interoperability endpoints

  • Direct secure messaging: mputnam102581@direct.urmc.rochester.edu

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.

Hospital & facility affiliations 3

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": "1574035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1396381000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W 6TH ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131262598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 WINTON RD S",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146183998",
            "telephone_number": "585-427-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTNAM",
        "first_name": "MISTY",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-18",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "024436",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NY",
            "license": "24436",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.