NPIMap

Organization Active NPI

Syracuse University

  • Speech-Language Pathologist
  • Syracuse, NY
National Provider Identifier
1609928217
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
SYRACUSE UNIVERSITY
Practice address
621 Skytop Rd
Suite 1200
Syracuse, NY 13244-5290
Phone
(315) 443-4485
Fax
(315) 443-4413
NPI assigned
Jan 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Authorized official

Name
Joseph Pellegrino, AUDNPI 1871787010
Title
Director, Gebbie Hearing Clinic
Phone
(315) 443-2352

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
Speech-Language PathologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 235Z00000X NY Primary

Addresses

Primary practice location

621 Skytop Rd
Suite 1200
Syracuse, NY 13244-5290

Mailing address

621 Skytop Rd
Suite 1200
Syracuse, NY 13244-5290
Phone (315) 443-4485

Other identifiers 1

IdentifierTypeStateIssuer
0T007OtherNYBILLING NUMBER - BCBS

Other names 1

  • Syracuse University Gebbie Speech Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100726000704 NY Part B Supplier - Clinic/Group Practice 8527191626 Receives reassigned benefits from 12 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Syracuse, NY

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Syracuse University4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

621 Skytop Rd
Ste 1200
Syracuse, NY 13244
Phone (315) 443-4301

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1609928217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 SKYTOP RD",
            "address_2": "SUITE 1200",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132445290",
            "telephone_number": "315-443-4485",
            "fax_number": "315-443-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 SKYTOP RD",
            "address_2": "SUITE 1200",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132445290",
            "telephone_number": "315-443-4485",
            "fax_number": "315-443-4413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYRACUSE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "PELLEGRINO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "DIRECTOR, GEBBIE HEARING CLINIC",
        "authorized_official_telephone_number": "315-443-2352",
        "authorized_official_credential": "AUD"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BILLING NUMBER - BCBS",
            "identifier": "0T007",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Syracuse University Gebbie Speech Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.