NPIMap

Organization Active NPI

Jefferson Anesthesiologist Services PC

  • Anesthesiology Physician
  • Watertown, NY
National Provider Identifier
1508818014
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
JEFFERSON ANESTHESIOLOGIST SERVICES PC
Practice address
830 Washington St
Watertown, NY 13601-4066
Phone
(315) 785-4313
Fax
(315) 779-5114
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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

Authorized official

Name
Mr. Bob Hawthorne
Title
President
Phone
(315) 785-8509

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

830 Washington St
Watertown, NY 13601-4066

Mailing address

PO Box 2001
East Syracuse, NY 13057-4501
Phone (315) 449-0513

Other identifiers 1

IdentifierTypeStateIssuer
01140587MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040512000314 NY Part B Supplier - Clinic/Group Practice 0840289260 Receives reassigned benefits from 82 practitioners
Practice locations: Watertown, NY

National Provider Directory

National Provider Directory

Locations

826 Washington St
Watertown, NY 13601
Phone (315) 782-1505

Practitioners & affiliated clinicians

Practitioners 85

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

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1508818014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2001",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574501",
            "telephone_number": "315-449-0513",
            "fax_number": "315-362-5120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014066",
            "telephone_number": "315-785-4313",
            "fax_number": "315-779-5114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON ANESTHESIOLOGIST SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "HAWTHORNE",
        "authorized_official_first_name": "BOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "315-785-8509",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01140587",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.