NPIMap

Organization Active NPI

Pulaski Medical Urgent Care, P.C

Doing business as Pulaski Urgent Care

  • Family Medicine Physician
  • Pulaski, NY
National Provider Identifier
1568829356
Registry record updated Feb 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
169461 Issued in NY
Legal business name
PULASKI MEDICAL URGENT CARE, P.C
Doing business as
Pulaski Urgent Care
Practice address
3858 State Route 13
Pulaski, NY 13142-2400
Phone
(315) 298-2273
NPI assigned
Jan 25, 2016
Last updated
Feb 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2016

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

Authorized official

Name
Dr. Jay F Sullivan, MDNPI 1861426413
Title
Owner
Phone
(315) 415-3529

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
Family Medicine Physician 207Q00000X 169461 NY Primary

Addresses

Primary practice location

3858 State Route 13
Pulaski, NY 13142-2400

Mailing address

PO Box 74
Pulaski, NY 13142-0074
Phone (315) 298-2273

Other identifiers 2

IdentifierTypeStateIssuer
03215529MedicaidNY
03297174MedicaidNY

Other names 1

  • PULASKI URGENT CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160328000380 NY Part B Supplier - Clinic/Group Practice 1951608579 Receives reassigned benefits from 10 practitioners
Practice locations: Pulaski, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2096216Pulaski Medical Urgent Care PC3858 State Rte 13, Pulaski, NY 13142Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Locations

3858 State Route 13
Pulaski, NY 13142
Phone (315) 298-2273

Practitioners & affiliated clinicians

Practitioners 11

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": "1453680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454976000000",
    "number": "1568829356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "131420074",
            "telephone_number": "315-298-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3858 STATE ROUTE 13",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "131422400",
            "telephone_number": "315-298-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULASKI MEDICAL URGENT CARE, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-25",
        "last_updated": "2016-02-09",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-415-3529",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "169461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03215529",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03297174",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PULASKI URGENT CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pulaski, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.