NPIMap

Individual provider Active NPI

Audra Hanley, M.D.

  • General Practice Physician
  • Ballston Lake, NY
National Provider Identifier
1588625271
Registry record updated Jan 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
204679-5 Issued in NY
Practice address
112 Charlton Rd
Ballston Lake, NY 12019-2547
Phone
(518) 399-7723
Fax
(518) 399-6428
NPI assigned
Mar 31, 2006
Last updated
Jan 29, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 204679-5 NY Primary

Addresses

Primary practice location

112 Charlton Rd
Ballston Lake, NY 12019-2547

Mailing address

112 Charlton Rd
Ballston Lake, NY 12019-2547
Phone (518) 399-7723

Other identifiers 1

IdentifierTypeStateIssuer
01866004MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100602000612 NY Practitioner - Family Practice 5092844951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of Ny Upstate Medical University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saratoga HospitalGroup PAC ID 6406740273, 353 clinicians

Practice addresses (Care Compare)

112 Charlton Rd
Ballston Lake, NY 12019-2547
Phone (518) 587-8400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
204679-5NYMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saratoga Hospital Current Accepting new patients
Saratoga Hospital CurrentSince Jan 1, 2013 Accepting new patients
Saratoga Hospital CurrentSince Jan 1, 2013 Accepting new patients
Scotia Glenville Family Medicine, P.C. Current Accepting new patients

Locations

112 Charlton Rd
Charlton, NY 12019
Phone (518) 399-7723

Organizations & group practices 4

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.

Hospital & facility affiliations 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359417600000",
    "number": "1588625271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 CHARLTON RD",
            "city": "BALLSTON LAKE",
            "state": "NY",
            "postal_code": "120192547",
            "telephone_number": "518-399-7723",
            "fax_number": "518-399-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 CHARLTON RD",
            "city": "BALLSTON LAKE",
            "state": "NY",
            "postal_code": "120192547",
            "telephone_number": "518-399-7723",
            "fax_number": "518-399-6428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANLEY",
        "first_name": "AUDRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-31",
        "last_updated": "2013-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "204679-5",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01866004",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ballston Lake, NY

Sources for this page

Verify at the official NPI Registry.