NPIMap

Individual provider Active NPI

Steven D Tiernan, PA

  • Physician Assistant
  • Watertown, NY
National Provider Identifier
1437191277
Registry record updated Aug 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
009062 Issued in NY
Practice address
22670 Summit Dr
Ste 3
Watertown, NY 13601-7208
Phone
(315) 755-2560
Fax
(315) 755-2597
NPI assigned
Jun 12, 2006
Last updated
Aug 31, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 009062 NY Primary

Addresses

Primary practice location

22670 Summit Dr
Ste 3
Watertown, NY 13601-7208

Mailing address

1575 Washington St
Watertown, NY 13601-9371
Phone (315) 786-7300

Other identifiers 2

IdentifierTypeStateIssuer
03731160MedicaidNY
00354316MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050112000849 NY Practitioner - Physician Assistant 1355390766 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Samaritan Medical CenterGroup PAC ID 8123914876, 157 clinicians

Practice addresses (Care Compare)

10881 US Route 11
Adams, NY 13605-3154
Phone (315) 232-4400

165 Coleman Ave
Watertown, NY 13601-2217
Phone (315) 755-2024

22567 Summit Dr
BLDG 2
Watertown, NY 13601-7210
Phone (315) 785-7230

909 Strawberry LN
Clayton, NY 13624-1409
Phone (315) 656-2094

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9062NYMDPsychologist
009062NYMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Medical Center CurrentSince Jan 10, 2023 Accepting new patients
David P Locastro, MD, PC Past Accepting new patients
Edward John Noble Hospital of Gouverneur Ny Swing Bed Unit Past Accepting new patients
Mountain Medical of Watertown Physician Assistant Past Accepting new patients
Edward John Noble Hospital of Gouverneur Ny Past Accepting new patients

Locations

1575 Washington St
Watertown, NY 13601
Phone (315) 779-5060

165 Coleman Ave
Watertown, NY 13601
Phone (315) 755-2024

830 Washington St
Watertown, NY 13601
Phone (315) 785-4000

Interoperability endpoints

  • Direct secure messaging: steven.tiernan@sfhcny.eclinicaldirectplus.com

Organizations & group practices 6

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 9

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440979200000",
    "number": "1437191277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136019371",
            "telephone_number": "315-786-7300",
            "fax_number": "315-786-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22670 SUMMIT DR",
            "address_2": "STE 3",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136017208",
            "telephone_number": "315-755-2560",
            "fax_number": "315-755-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIERNAN",
        "first_name": "STEVEN",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2015-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "009062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03731160",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00354316",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

Verify at the official NPI Registry.