Individual provider Active NPI

Clinton Ingersol, M.D.

  • Surgery Physician
  • Syracuse, NY
National Provider Identifier
1427599604
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
326196 Issued in NY
Practice address
739 Irving Ave Ste 450
Syracuse, NY 13210-1663
Phone
(315) 470-7364
NPI assigned
Mar 20, 2017
Last updated
Jan 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X LT20455 ND
Surgery Physician 208600000X 326196 NY Primary

Addresses

Primary practice location

739 Irving Ave Ste 450
Syracuse, NY 13210-1663

Mailing address

1001 W Fayette St Ste 400
Syracuse, NY 13204-2866
Phone (315) 937-3433

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240103000094 ND Practitioner - General Surgery 8123397759 Reassigns benefits to 1 organization
I20240109002669 NY Practitioner - General Surgery 8123397759 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crouse Medical Practice PLLCGroup PAC ID 8426189622, 187 clinicians

Practice addresses (Care Compare)

739 Irving Ave
Suite 450
Syracuse, NY 13210-1663
Phone (315) 470-7364

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LT20455NDMDSurgery Physician
326196NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crouse Health Hospital, Inc. CurrentSince Feb 13, 2025 Accepting new patients
St Alexius Medical Center CurrentSince Nov 26, 2023 Accepting new patients
St. Alexius Medical Center CurrentSince Nov 26, 2023 Accepting new patients
Crouse Medical Practice PLLC CurrentSince Jan 15, 2024 Accepting new patients
Pathology Associates of Syracuse, PC Current Accepting new patients
Crouse Health Hospital Inc Surgery CurrentSince Feb 13, 2025 Accepting new patients
Crouse Medical Practice, PLLC CurrentSince Jan 15, 2024 Accepting new patients
Crouse Medical Practice PLLC Past Accepting new patients

Locations

900 E Broadway Ave
Bismarck, ND 58501
Phone (701) 530-7300

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

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

739 Irving Ave
Ste 450
Syracuse, NY 13210
Phone (315) 470-7364

Interoperability endpoints

  • Direct secure messaging: cingersol@crousemed.medentdirect.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1427599604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST STE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042866",
            "telephone_number": "315-937-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE STE 450",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101663",
            "telephone_number": "315-470-7364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGERSOL",
        "first_name": "CLINTON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-20",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ND",
            "license": "LT20455",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "326196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.