Individual provider Active NPI

Andrew P Hathaway, M.D.

  • Internal Medicine Physician
  • East Syracuse, NY
National Provider Identifier
1467793273
Registry record updated Mar 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
264018-1 Issued in NY
Practice address
5000 Brittonfield Pkwy Ste A100
East Syracuse, NY 13057-9227
Phone
(315) 449-3800
Fax
(315) 449-0558
NPI assigned
Mar 5, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 264018 NY
Internal Medicine Physician 207R00000X 264018-1 NY Primary

Addresses

Primary practice location

5000 Brittonfield Pkwy Ste A100
East Syracuse, NY 13057-9227

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
03566525MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ahathaway@crousemed.medentdirect.com Direct Crouse Medical Practice, PLLC

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
I20130510000386 NY Practitioner - Family Practice 1355588336 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of Ny Upstate Medical University, 2004
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)

5000 Brittonfield Pkwy
Suite A100
East Syracuse, NY 13057-9227
Phone (315) 449-3800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
264018NYMDFamily Medicine Physician
264018-1NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crouse Medical Practice PLLC CurrentSince Mar 1, 2019 Accepting new patients
Crouse Medical Practice, PLLC Internal Medicine CurrentSince Mar 1, 2019 Accepting new patients
St Josephs Medical PC Family Medicine CurrentSince Apr 1, 2013 Accepting new patients
North Medical PC Family Medicine Current Accepting new patients

Locations

5000 Brittonfield Pkwy
Ste A100
East Syracuse, NY 13057
Phone (315) 449-3800

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

5100 W Taft Rd
Ste 1C
Liverpool, NY 13088
Phone (315) 452-2333

7209 Buckley Rd
Liverpool, NY 13088
Phone (315) 299-5451

301 Prospect Ave
Rm 1605
Syracuse, NY 13203

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

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

Interoperability endpoints

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

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 4

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": "1362441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1467793273",
    "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",
            "fax_number": "315-449-0558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 BRITTONFIELD PKWY STE A100",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579227",
            "telephone_number": "315-449-3800",
            "fax_number": "315-449-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "ANDREW",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-05",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "264018",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "264018-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03566525",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ahathaway@crousemed.medentdirect.com",
            "affiliation": "Y",
            "endpointDescription": "email address in Medent",
            "affiliationName": "Crouse Medical Practice, PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "5000 Brittonfield Pkwy Ste A100",
            "city": "East Syracuse",
            "state": "NY",
            "country_code": "US",
            "postal_code": "130579227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in East Syracuse, NY

Sources for this page

Verify at the official NPI Registry.