Individual provider Active NPI

Elaine Tsukayama, MD

  • Pediatrics Physician
  • Utica, NY
National Provider Identifier
1578874459
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
292820 Issued in NY
Practice address
117 Business Park Dr
Utica, NY 13502-6303
Phone
(315) 798-1543
NPI assigned
Jun 25, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 292820 NY Primary

Addresses

Primary practice location

117 Business Park Dr
Utica, NY 13502-6303

Mailing address

117 Business Park Dr
Utica, NY 13502-6303
Phone (315) 798-1543

Other identifiers 1

IdentifierTypeStateIssuer
05081741MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161104001973 HI Practitioner - Pediatric Medicine 0941438048 Reassigns benefits to 1 organization
I20180326001278 NY Practitioner - Pediatric Medicine 0941438048 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Loma Linda University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Slocum Dickson Medical Group PLLCGroup PAC ID 5799778510, 79 clinicians

Practice addresses (Care Compare)

117 Business Park Dr
Utica, NY 13502-6303
Phone (315) 798-1500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Kapiolani Medical Specialists CurrentSince Oct 14, 2016 Accepting new patients
United Medical Associates, P.C. CurrentSince Mar 12, 2018 Accepting new patients
United Medical Associates PC CurrentSince Mar 12, 2018 Accepting new patients
Slocum Dickson Medical Group PLLC CurrentSince May 4, 2025 Accepting new patients
Wwu Campus Health & Wellness Past Accepting new patients

Locations

1319 Punahou St
Honolulu, HI 96826
Phone (808) 485-4300

33 Lewis Rd
Fl 2
Binghamton, NY 13905
Phone (607) 729-8156

33-57 Harrison St
Johnson City, NY 13790
Phone (607) 763-6412

1729 Burrstone Rd
New Hartford, NY 13413
Phone (315) 798-1500

179 River St
Oneonta, NY 13820
Phone (607) 432-8477

117 Business Park Dr
Utica, NY 13502
Phone (315) 798-1543

Interoperability endpoints

  • Direct secure messaging: etsukayama55898@mvhealthsystem.direct-ci.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1578874459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 BUSINESS PARK DR",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026303",
            "telephone_number": "315-798-1543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 BUSINESS PARK DR",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135026303",
            "telephone_number": "315-798-1543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSUKAYAMA",
        "first_name": "ELAINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-25",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "292820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05081741",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, NY

Sources for this page

Verify at the official NPI Registry.