Individual provider Active NPI

Rusty Landon, PA-C

  • Physician Assistant
  • Liverpool, NY
National Provider Identifier
1538912241
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
031731 Issued in NY
Practice address
7375 Oswego Rd
Liverpool, NY 13090-3717
Phone
(315) 291-0064
NPI assigned
Apr 10, 2024
Last updated
Apr 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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 031731 NY Primary

Addresses

Primary practice location

7375 Oswego Rd
Liverpool, NY 13090-3717

Mailing address

103 Footprint Cir
Liverpool, NY 13088-4365

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240510002111 NY Practitioner - Physician Assistant 5698116408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellnow Urgent Care, P.C.Group PAC ID 8325320864, 395 clinicians

Practice addresses (Care Compare)

1600 Erie Blvd E
Syracuse, NY 13210-1212
Phone (315) 401-3204

3800 W Genesee St
Syracuse, NY 13219-1928
Phone (315) 552-9080

3840 State Route 31
Liverpool, NY 13090-1310
Phone (315) 715-6319

6227 Thompson Rd
Syracuse, NY 13206-1405
Phone (315) 937-2007

7375 Oswego Rd
Suite 1
Liverpool, NY 13090-3717
Phone (315) 291-0064

8003 Brewerton Rd
Cicero, NY 13039-9528
Phone (315) 288-4006

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
031731NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Wellnow Urgent Care, PC CurrentSince May 20, 2024 Accepting new patients

Locations

11 Maple Ave
Catskill, NY 12414
Phone (518) 625-3608

446 Fairview Ave
Ste 200
Hudson, NY 12534
Phone (518) 267-3496

7375 Oswego Rd
#1
Liverpool, NY 13090
Phone (315) 291-0064

225 S Cascade Dr
Springville, NY 14141
Phone (716) 599-1163

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1712707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1538912241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 FOOTPRINT CIR",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130884365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7375 OSWEGO RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130903717",
            "telephone_number": "315-291-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDON",
        "first_name": "RUSTY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-10",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "031731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.