Evgenia Baranova, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Fayetteville, NY
NPI 1649866252 · NPPES record last updated Dec 17, 2020
Key facts
- NPI
- 1649866252
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 346494- (NY)
- Practice address
- 510 Towne Dr
Fayetteville, NY 13066-1331 - Phone
- (315) 663-0500
- Fax
- (315) 663-0511
- NPI assigned
- Dec 17, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in
Practice addresses (Care Compare)
510 Towne Dr
Fayetteville, NY 13066-1331
Phone (315) 663-0500
Hospital & facility affiliations
- University Hospital S U N Y Health Science Center
- Oswego Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.56 of 100
- Quality
- 71.97
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.04
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210219000890 | NY | Practitioner - Nurse Practitioner | 5395150627 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 346494- | NY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in | Single Specialty | Current |
Accepting new patients |
| Department of Medicine Medical Service Group | Single Specialty | Current |
Accepting new patients |
| Urban Family Practice PC | Single Specialty | Past | Accepting new patients |
Locations
510 Towne Dr
Fayetteville, NY 13066
Phone (315) 637-4747
5112 W Taft Rd
Ste J
Liverpool, NY 13088
Phone (315) 701-2170
750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363
Interoperability endpoints
- evgenia.baranova@cinq-nyipa.medentdirect.com
- ebaranova114052@direct.upstate.edu
- evgenia.baranova.1@29290.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | 346494- | NY | Yes |
Addresses
Primary practice location
510 Towne Dr
Fayetteville, NY 13066-1331
Mailing address
510 Towne Dr
Fayetteville, NY 13066-1331
Phone (315) 663-0500
Other providers in Fayetteville, NY
- Gurcharan Bahia
- Cynthia Leigh Bahn
- Nicole Bailey
- Kelly Gossard Baker
- Natalie Bamerick
- Barb Shepard Licensed Mental Health Counselor PLLC
- Michelle Easterly Barber
- Thomas Barnello
- George Barrett
- Anthony Vincent Basile
All providers in Fayetteville, NY · Family Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.