Individual provider Active NPI

Edward G Wolfe, RPA

  • Medical Physician Assistant
  • Liverpool, NY
National Provider Identifier
1669434536
Registry record updated Feb 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
004068 Issued in NY
Practice address
5100 W Taft Rd
Suite 1C
Liverpool, NY 13088-3807
Phone
(315) 452-2333
Fax
(315) 452-2336
NPI assigned
Apr 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0040681 NY
Physician Assistant 363A00000X
Medical Physician Assistant 363AM0700X 004068 NY Primary

Addresses

Primary practice location

5100 W Taft Rd
Suite 1C
Liverpool, NY 13088-3807

Mailing address

5100 W Taft Rd
Suite 1C
Liverpool, NY 13088-3807
Phone (315) 452-2333

Other practice location 1

739 Irving Ave Ste 200-300
Syracuse, NY 13210-1651
Phone (315) 479-5070

Other identifiers 1

IdentifierTypeStateIssuer
02366030MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090603000648 NY Practitioner - Physician Assistant 4082764592 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Oswego County Health Services, Inc.Group PAC ID 8426961541, 37 clinicians

Practice addresses (Care Compare)

61 Delano St
Pulaski, NY 13142-1400
Phone (315) 298-6569

Hospital & facility affiliations

  • Oswego Hospital Hospital, Oswego, NY, CCN 330218
  • Samaritan Medical Center Hospital, Watertown, NY, CCN 330157

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0040681NYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Oswego County Health Services, Inc. CurrentSince Oct 11, 2021 Accepting new patients

Locations

61 Delano St
Pulaski, NY 13142
Phone (315) 298-4274

Interoperability endpoints

  • Direct secure messaging: ewolfe@hiemail.healtheconnections.org
  • Direct secure messaging: edward.wolfe@nochsi.directbygreenway.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551139200000",
    "number": "1669434536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD",
            "address_2": "SUITE 1C",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883807",
            "telephone_number": "315-452-2333",
            "fax_number": "315-452-2336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD",
            "address_2": "SUITE 1C",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883807",
            "telephone_number": "315-452-2333",
            "fax_number": "315-452-2336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "739 Irving Ave Ste 200-300",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132101651",
            "country_code": "US",
            "telephone_number": "315-479-5070",
            "fax_number": "315-701-2525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLFE",
        "first_name": "EDWARD",
        "middle_name": "G",
        "credential": "RPA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "0040681",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "004068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02366030",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.