Individual provider Active NPI

Kathryn Cooper, NP

  • Adult Medicine Physician
  • Syracuse, NY
National Provider Identifier
1750377479
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
F331842 Issued in NY
Practice address
739 Irving Ave Ste 500
Syracuse, NY 13210-1664
Phone
(315) 470-7409
NPI assigned
Sep 27, 2005
Last updated
Aug 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F331842 NY
Adult Medicine Physician 207QA0505X F331842 NY Primary

Addresses

Primary practice location

739 Irving Ave Ste 500
Syracuse, NY 13210-1664

Mailing address

1001 W Fayette St Ste 400
Syracuse, NY 13204-2866
Phone (315) 937-3433

Other identifiers 1

IdentifierTypeStateIssuer
02054626MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kcooper@crousemed.medentdirect.com Direct Crouse Medical Practice, PLLC

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
I20071217000551 NY Practitioner - Nurse Practitioner 4981794765 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crouse Medical Practice PLLCGroup PAC ID 8426189622, 187 clinicians

Practice addresses (Care Compare)

5417 W Genesee St
Camillus, NY 13031-2176
Phone (315) 476-2323

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F331842NYMDAdult Medicine Physician
331842NYMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crouse Medical Practice PLLC CurrentSince Aug 12, 2024 Accepting new patients
Crouse Medical Practice, PLLC Nurse Practitioner CurrentSince Aug 12, 2024 Accepting new patients
St Josephs Medical PC CurrentSince Dec 1, 2016 Accepting new patients
North Medical PC Current Accepting new patients

Locations

5417 W Genesee St
Camillus, NY 13031
Phone (315) 418-4043

5000 Brittonfield Pkwy
Ste B101
East Syracuse, NY 13057
Phone (315) 470-7409

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

1000 E Genesee St
Ste 300
Syracuse, NY 13210
Phone (315) 471-1044

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

739 Irving Ave
Ste 500
Syracuse, NY 13210
Phone (315) 453-4262

Interoperability endpoints

  • Direct secure messaging: cooperk@hiemail.healtheconnections.org
  • Direct secure messaging: kathryncooper@crousemed.medentdirect.com

Organizations & group practices 4

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.

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": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1750377479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST STE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042866",
            "telephone_number": "315-937-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE STE 500",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101664",
            "telephone_number": "315-470-7409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "KATHRYN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-27",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F331842",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NY",
            "license": "F331842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02054626",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcooper@crousemed.medentdirect.com",
            "affiliation": "Y",
            "endpointDescription": "email address in Medent",
            "affiliationName": "Crouse Medical Practice, PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kcooper@crousemed.medentdirect.com",
            "address_1": "739 Irving Ave Ste 500",
            "city": "Syracuse",
            "state": "NY",
            "country_code": "US",
            "postal_code": "132101664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.