Individual provider Active NPI

Gregory Conners, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Syracuse, NY
National Provider Identifier
1417976986
Registry record updated Feb 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
194992 Issued in NY
Practice address
750 East Adams St
Syracuse, NY 13210
Phone
(315) 464-5450
Fax
(315) 464-6322
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 194992 NY
Pediatrics Physician 208000000X 2009009261 MO
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 2009009261 MO
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 194992 NY Primary

Addresses

Primary practice location

750 East Adams St
Syracuse, NY 13210

Mailing address

251 Salina Meadows Pkwy Ste 100
Syracuse, NY 13212-4516
Phone (315) 464-2000

Other identifiers 1

IdentifierTypeStateIssuer
01720878MedicaidNY

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190315001884 NY Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 4082500723 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2009009261MOMDPediatrics Physician
194992NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upstate Emergency Medicine, Inc CurrentSince Mar 1, 2019 Accepting new patients
Pediatric Service Group Pediatrics PastSince Mar 1, 2019 Accepting new patients

Locations

251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212
Phone (315) 464-2000

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

Interoperability endpoints

  • Direct secure messaging: gconners87841@direct.upstate.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.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551225600000",
    "number": "1417976986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 SALINA MEADOWS PKWY STE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132124516",
            "telephone_number": "315-464-2000",
            "fax_number": "315-464-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 EAST ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-464-5450",
            "fax_number": "315-464-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNERS",
        "first_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2019-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "194992",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2009009261",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "MO",
            "license": "2009009261",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "NY",
            "license": "194992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01720878",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.