Individual provider Active NPI

Edgardo Arrazola, MD

  • Family Medicine Physician
  • Syracuse, NY
National Provider Identifier
1427617240
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
312329 Issued in NY
Practice address
90 Presidential PLZ
Syracuse, NY 13202-2240
Phone
(315) 464-4686
NPI assigned
Jun 6, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 312329 NY Primary

Addresses

Primary practice location

90 Presidential PLZ
Syracuse, NY 13202-2240

Mailing address

251 Salina Meadows Pkwy Ste 100
Syracuse, NY 13212-4516

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
I20220601001387 NY Practitioner - Family Practice 9638557705 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upstate Family and Preventive Medicine IncGroup PAC ID 6800185711, 30 clinicians

Practice addresses (Care Compare)

90 Presidential PLZ
Syracuse, NY 13202-2240
Phone (315) 464-4686

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
312329NYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Josephs Medical PC Family Medicine CurrentSince Jul 12, 2022 Accepting new patients
Upstate Family and Preventive Medicine, Inc Family Medicine CurrentSince Jun 1, 2022 Accepting new patients
Family Medicine Medical Service Group Family Medicine PastSince Jul 23, 2015 Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients

Locations

4101 Medical Center Dr
Fayetteville, NY 13066
Phone (315) 637-7878

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

90 Presidential Plz
Syracuse, NY 13202
Phone (315) 464-3836

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

4900 Broad Rd
Ste 3
Syracuse, NY 13215
Phone (315) 492-3400

6712 Brooklawn Pkwy
Ste 204
Syracuse, NY 13211
Phone (315) 432-8899

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

725 E Adams St
Fl 4
Syracuse, NY 13210
Phone (315) 464-4686

Interoperability endpoints

  • Direct secure messaging: earrazola97124@direct.upstate.edu

Organizations & group practices 4

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 1

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": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1427617240",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 PRESIDENTIAL PLZ",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132022240",
            "telephone_number": "315-464-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARRAZOLA",
        "first_name": "EDGARDO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-06",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "312329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.