Marlee Anne Fallon, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

019993-1 Issued in NY

Practice address

4402 Medical Center Dr Ste 402
Fayetteville, NY 13066-6626

Phone

(315) 663-0005

NPI assigned

Apr 16, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: marleeheintzpa@asthmaandallergy.medentdirect.com

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.

• Asthma & Allergy Associates P.C.

  • Allergy Physician
  • Ithaca, NY
  • NPI 1063503191

  NY

  Medicare reassignment
• Southern College of Optometry

  • Optometrist
  • Memphis, TN
  • NPI 1851384986
  NPD (past)

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1578050480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 MEDICAL CENTER DR STE 402",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666626",
            "telephone_number": "315-663-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 MEDICAL CENTER DR STE 402",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666626",
            "telephone_number": "315-663-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLON",
        "first_name": "MARLEE",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-16",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "019993-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastside Audiology Services, LLC
• Janet Eatman, M.A., CCC-SLP
• Errol S McKenzie MD PLLC
• Essentia Telehealth and Wellness
• Essentia Telehealth Wellness, LCSW, PLLC
• Family Medical Care of Dewitt PLLC
• Sara Lou Farchione, MD
• Fateh Supply Inc
• Fayetteville Dental Associates
• Fayetteville Family Dentistry

• All providers in Fayetteville, NY
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.