NPIMap

Organization Active NPI

Adirondack Cross Roads Psychology PLLC

  • Clinical Psychologist
  • Queensbury, NY
National Provider Identifier
1528378692
Registry record updated Oct 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
010511 Issued in NY
Legal business name
ADIRONDACK CROSS ROADS PSYCHOLOGY PLLC
Practice address
123 Dixon Rd
Queensbury, NY 12804-2133
Phone
(518) 798-2088
Fax
(518) 798-2088
NPI assigned
Oct 7, 2010
Last updated
Oct 7, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2010

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

Authorized official

Name
Dr. Paul Gerard Schulze, PSYDNPI 1952493538
Title
Original Manager/ Owner
Phone
(518) 798-2088

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 010511 NY Primary

Addresses

Primary practice location

123 Dixon Rd
Queensbury, NY 12804-2133

Mailing address

123 Dixon Rd
Queensbury, NY 12804-2133
Phone (518) 798-2088

Other identifiers 6

IdentifierTypeStateIssuer
137679OtherNYVALUE OPTIONS
200207781OtherNYCDPHP
01675901MedicaidNY
VE9702OtherNYEMPIRE BLUE CROSS BLUE SHIELD
000405218002OtherNYBLUE SHIELD OF NORTHEASTERN NEW YORK
41202OtherNYMVP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221021000207 NY Part B Supplier - Clinic/Group Practice 6507046109 Receives reassigned benefits from 1 practitioner
Practice locations: Queensbury, NY

National Provider Directory

National Provider Directory

Locations

123 Dixon Rd
Queensbury, NY 12804
Phone (518) 792-8500

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1286409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286409600000",
    "number": "1528378692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 DIXON RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128042133",
            "telephone_number": "518-798-2088",
            "fax_number": "518-798-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 DIXON RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128042133",
            "telephone_number": "518-798-2088",
            "fax_number": "518-798-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADIRONDACK CROSS ROADS PSYCHOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-07",
        "last_updated": "2010-10-07",
        "status": "A",
        "authorized_official_last_name": "SCHULZE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "GERARD",
        "authorized_official_title_or_position": "ORIGINAL MANAGER/ OWNER",
        "authorized_official_telephone_number": "518-798-2088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "010511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "137679",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "200207781",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01675901",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUE CROSS BLUE SHIELD",
            "identifier": "VE9702",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF NORTHEASTERN NEW YORK",
            "identifier": "000405218002",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "41202",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Queensbury, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; 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.