Individual provider Active NPI

Alexandra Pesold, FNP

  • Family Nurse Practitioner
  • Massena, NY
National Provider Identifier
1679204200
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
349646 Issued in NY
Practice address
17 Hospital Dr
Massena, NY 13662-1093
Phone
(315) 769-4700
NPI assigned
Jun 23, 2022
Last updated
Feb 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 349646 NY Primary

Addresses

Primary practice location

17 Hospital Dr
Massena, NY 13662-1093

Mailing address

25 Park St
Canton, NY 13617-1265
Phone (315) 379-9158

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
I20220825001784 NY Practitioner - Nurse Practitioner 9830573898 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Oct 19, 2024 Accepting new patients
Healey Medical Practice, PLLC CurrentSince Jun 22, 2022 Accepting new patients
Canton-Potsdam Hospital CurrentSince Oct 19, 2024 Accepting new patients
Massena Hospital, Inc CurrentSince Feb 13, 2024 Accepting new patients
Massena Hospital Inc CurrentSince Feb 13, 2024 Accepting new patients

Locations

25 Park St
Canton, NY 13617
Phone (315) 379-9158

80 E Main St
Canton, NY 13617
Phone (315) 261-6034

1 Hospital Dr
Massena, NY 13662
Phone (315) 764-1711

17 Hospital Dr
Massena, NY 13662
Phone (315) 265-3458

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

49 Lawrence Ave
Potsdam, NY 13676
Phone (315) 261-5550

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

Interoperability endpoints

  • Direct secure messaging: apesold386928@direct.rochesterregional.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1679204200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 PARK ST",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "136171265",
            "telephone_number": "315-379-9158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 HOSPITAL DR",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136621093",
            "telephone_number": "315-769-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESOLD",
        "first_name": "ALEXANDRA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-23",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "349646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massena, NY

Sources for this page

Verify at the official NPI Registry.