Active NPI
Elizabeth Ellen Nicholas, M.D.
- Emergency Medicine Physician
- Syracuse, NY
National Provider Identifier
1598910911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 270884
- Practice address
- 750 E Adams St
Syracuse, NY 13210-2342 - Phone
- (315) 464-4363
- Fax
- (315) 464-8690
- NPI assigned
- Nov 26, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 0101249441 | VA | |
| Emergency Medicine Physician | 207P00000X | MD438784 | PA | |
| Emergency Medicine Physician | 207P00000X | 270884 | NY | Primary |
Addresses
Primary practice location
750 E Adams St
Syracuse, NY 13210-2342
Mailing address
750 E Adams St
Syracuse, NY 13210-2342
Phone (315) 464-4363
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 270884 | NY | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upstate Emergency Medicine, Inc | Emergency Medicine | Current | Accepting new patients |
Locations
251 Salina Meadows Pkwy
Ste 100
Syracuse, NY 13212
Phone (315) 464-2000
750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363
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 and National Provider Directory roles.
-
- Emergency Medicine Physician
- Syracuse, NY
- NPI 1275589582
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384992000000",
"number": "1598910911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 E ADAMS ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132102342",
"telephone_number": "315-464-4363",
"fax_number": "315-464-8690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 E ADAMS ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132102342",
"telephone_number": "315-464-4363",
"fax_number": "315-464-8690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLAS",
"first_name": "ELIZABETH",
"middle_name": "ELLEN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-26",
"last_updated": "2013-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "VA",
"license": "0101249441",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "PA",
"license": "MD438784",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NY",
"license": "270884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; 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.