Active NPI
Elizabeth Kramer
- Pediatrics Physician
- Fort Drum, NY
National Provider Identifier
1720188204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036-104993
- Practice address
- 11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438 - Phone
- (315) 772-2778
- NPI assigned
- Sep 24, 2006
- Last updated
- Aug 26, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036-104993 | IL | Primary |
Addresses
Primary practice location
11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
Mailing address
USA Meddac 11050 Mt. Belvedere Blvd
Fort Drum, NY 13602
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 306104993 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-104993 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724630400000",
"number": "1720188204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "USA MEDDAC 11050 MT. BELVEDERE BLVD",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "13602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11050 MOUNT BELVEDERE BLVD",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025438",
"telephone_number": "315-772-2778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRAMER",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-24",
"last_updated": "2024-08-26",
"certification_date": "2024-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036-104993",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "306104993",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Drum, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.