Individual provider Active NPI

Jason M Wallen, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Syracuse, NY
National Provider Identifier
1730285370
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
282319 Issued in NY
Practice address
750 East Adams St
Syracuse, NY 13210
Phone
(315) 464-1800
Fax
(315) 464-6238
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A81230 CA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 282319 NY Primary

Addresses

Primary practice location

750 East Adams St
Syracuse, NY 13210

Mailing address

251 Salina Meadows Pkwy Ste 100
Syracuse, NY 13212-4516
Phone (315) 464-2000

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160204000087 NY Practitioner - Thoracic SurgeryPractitioner - General Surgery 3577645290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: General Surgery
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Surgical Associates LLPGroup PAC ID 7315834165, 49 clinicians

Practice addresses (Care Compare)

725 Irving Ave
Suite 401
Syracuse, NY 13210-1684
Phone (315) 464-2878

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.86 of 100Reported as group
Quality
83.98
Promoting interoperability
100
Improvement activities
40
Cost
78.23

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
81230CAMDMarriage & Family Therapist
A81230CAMDSurgery Physician
282319NYMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Suny Health Science Center at Syracuse Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jwallen52334@direct.upstate.edu

Organizations & group practices 2

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1730285370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 SALINA MEADOWS PKWY STE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132124516",
            "telephone_number": "315-464-2000",
            "fax_number": "315-464-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 EAST ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-464-1800",
            "fax_number": "315-464-6238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "JASON",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A81230",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NY",
            "license": "282319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.