NPIMap

Organization Active NPI

St Lawrence County

  • Community/Behavioral Health Agency
  • Canton, NY
National Provider Identifier
1699898635
Registry record updated Jan 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
ST LAWRENCE COUNTY
Practice address
80 State Highway 310 Ste 1
Canton, NY 13617-1436
Phone
(315) 386-2167
Fax
(315) 386-2435
NPI assigned
Apr 6, 2007
Last updated
Jan 6, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
ST LAWRENCE COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2023

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

Authorized official

Name
Mr. Jay M Ulrich
Title
Director
Phone
(315) 386-3562

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Social Worker 104100000X NU
Community/Behavioral Health Agency 251S00000X NY Primary

Addresses

Primary practice location

80 State Highway 310 Ste 1
Canton, NY 13617-1436

Mailing address

80 State Highway 310
Suite 1
Canton, NY 13617-1493
Phone (315) 386-2167

Other practice location 1

80 State Highway 310
Suite 1
Canton, NY 13617-1493
Phone (315) 386-2167

Other identifiers 1

IdentifierTypeStateIssuer
00655803MedicaidNY

Other names 1

  • St Lawrence County Community Services Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments
Opioid treatment program
Medicare-enrolled since Jul 18, 2022

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071217000660 NY Part B Supplier - Clinic/Group Practice 9436249224 Receives reassigned benefits from 5 practitioners
Practice locations: Canton, NY
O20240409001693 NY Part A Provider - Other 9436249224 Practice locations: Canton, NY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • St Lawrence County

    dba St Lawrence County Public Health - Clinic

    • Multi-Specialty Clinic/Center
    • Canton, NY
    • NPI 1861551822

    9436249224

    Same PAC ID

National Provider Directory

National Provider Directory
Part of
St Lawrence County Public Health

Locations

80 State Highway 310
Ste 1
Canton, NY 13617
Phone (315) 386-2167

21 Harrowgate Cmns
Massena, NY 13662
Phone (315) 764-0718

206 Ford St
Ogdensburg, NY 13669
Phone (315) 229-3875

Practitioners & affiliated clinicians

Practitioners 98

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 98

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672963200000",
    "number": "1699898635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 STATE HIGHWAY 310",
            "address_2": "SUITE 1",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "136171493",
            "telephone_number": "315-386-2167",
            "fax_number": "315-386-2435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 STATE HIGHWAY 310 STE 1",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "136171436",
            "telephone_number": "315-386-2167",
            "fax_number": "315-386-2435"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 State Highway 310",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "NY",
            "postal_code": "136171493",
            "country_code": "US",
            "telephone_number": "315-386-2167",
            "fax_number": "315-386-2435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST LAWRENCE COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST LAWRENCE COUNTY",
        "enumeration_date": "2007-04-06",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A",
        "authorized_official_last_name": "ULRICH",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "315-386-3562",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00655803",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Lawrence County Community Services",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "St Lawrence County Community Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Canton, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; 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.