NPIMap

Organization Active NPI

Upstate Orthopedics Ambulatory Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • East Syracuse, NY
National Provider Identifier
1427282771
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
3321200R Issued in NY
Legal business name
UPSTATE ORTHOPEDICS AMBULATORY SURGERY CENTER LLC
Doing business as
Upstate Orthopedics ASC
Practice address
6620 Fly Road
Suite 300
East Syracuse, NY 13057
Phone
(315) 432-5960
Fax
(315) 432-5979
NPI assigned
May 14, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Mr. Jon David Van Valkenburg
Title
Executive Director
Phone
(315) 432-5971

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X
Ambulatory Surgical Clinic/Center 261QA1903X 3321200R NY Primary

Addresses

Primary practice location

6620 Fly Road
Suite 300
East Syracuse, NY 13057

Mailing address

6620 Fly Road
Suite 300
East Syracuse, NY 13057
Phone (315) 432-5960

Other names 1

  • Upstate Orthopedics ASC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100202000249 NY Part B Supplier - Ambulatory Surgical Center 7416090295 Practice locations: East Syracuse, NY

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Upstate Orthopedics Ambulatory Surgery Center LLCCCN 33C0001104
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1242259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1427282771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6620 FLY ROAD",
            "address_2": "SUITE 300",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "13057",
            "telephone_number": "315-432-5960",
            "fax_number": "315-432-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 FLY ROAD",
            "address_2": "SUITE 300",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "13057",
            "telephone_number": "315-432-5960",
            "fax_number": "315-432-5979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE ORTHOPEDICS AMBULATORY SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-14",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "VAN VALKENBURG",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-432-5971",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NY",
            "license": "3321200R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upstate Orthopedics ASC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; 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.