NPIMap

Individual provider Active NPI

Paul Anthony Fiacco, M.D.

  • Family Medicine Physician
  • East Syracuse, NY
National Provider Identifier
1740277623
Registry record updated Sep 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1762201 Issued in NY
Practice address
4939 Brittonfield Pkwy
East Syracuse, NY 13057-9208
Phone
(315) 463-1600
Fax
(315) 634-6793
NPI assigned
Oct 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1762201 NY Primary

Addresses

Primary practice location

4939 Brittonfield Pkwy
East Syracuse, NY 13057-9208

Mailing address

4939 Brittonfield Pkwy
East Syracuse, NY 13057-9208
Phone (315) 463-1600

Other identifiers 1

IdentifierTypeStateIssuer
01937544MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100105000461 NY Practitioner - Family Practice 7113831991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of Ny Upstate Medical University, 1987
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Select PT, OT and SLP Rehabilitation Ny, PLLCGroup PAC ID 3870986656, 261 clinicians
Cny Family Care LLPGroup PAC ID 6901710896, 29 clinicians

Practice addresses (Care Compare)

125 Harry Howard Ave
Hudson, NY 12534-1601
Phone (800) 479-7695

4939 Brittonfield Pkwy
Suite 101
East Syracuse, NY 13057-9208
Phone (315) 463-1600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions47
Removal of nail tissue1-10
Removal or shaving of skin growth25
Skin biopsy11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1762201NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cny Family Care, LLP Family Medicine CurrentSince Mar 1, 1999 Accepting new patients

Locations

4939 Brittonfield Pkwy
Ste 101
East Syracuse, NY 13057
Phone (315) 463-1600

4939 Brittonfield Pkwy
East Syracuse, NY 13057
Phone (315) 463-1600

Interoperability endpoints

  • Direct secure messaging: pfiacco@cnyfamilycare.medentdirect.com

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 8

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": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378944000000",
    "number": "1740277623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4939 BRITTONFIELD PKWY",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579208",
            "telephone_number": "315-463-1600",
            "fax_number": "315-634-6793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4939 BRITTONFIELD PKWY",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130579208",
            "telephone_number": "315-463-1600",
            "fax_number": "315-634-6793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIACCO",
        "first_name": "PAUL",
        "middle_name": "ANTHONY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2013-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "1762201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01937544",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Syracuse, NY

Sources for this page

Verify at the official NPI Registry.