Individual provider Active NPI

Jean Rybinski, PA

  • Medical Physician Assistant
  • Syracuse, NY
National Provider Identifier
1790007375
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
013818 Issued in NY
Practice address
5794 Widewaters Pkwy
Syracuse, NY 13214-1845
Phone
(315) 422-1513
Fax
(315) 422-5890
NPI assigned
Feb 23, 2010
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 013818 NY Primary

Addresses

Primary practice location

5794 Widewaters Pkwy
Syracuse, NY 13214-1845

Mailing address

5794 Widewaters Pkwy
Syracuse, NY 13214-1845
Phone (315) 422-1513

Other identifiers 1

IdentifierTypeStateIssuer
04575908MedicaidNY

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
I20160622002227 NY Practitioner - Physician Assistant 9335430347 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
013818NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Medicine Medical Serv GRP at Suny HLTH Sci Ctr Syr in CurrentSince May 1, 2021 Accepting new patients
Department of Medicine Medical Service Group CurrentSince May 1, 2021 Accepting new patients

Locations

1000 E Genesee St
Ste 403
Syracuse, NY 13210
Phone (315) 464-2929

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1266883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1790007375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5794 WIDEWATERS PKWY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141845",
            "telephone_number": "315-422-1513",
            "fax_number": "315-422-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5794 WIDEWATERS PKWY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141845",
            "telephone_number": "315-422-1513",
            "fax_number": "315-422-5890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYBINSKI",
        "first_name": "JEAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "013818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04575908",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.