Individual provider Active NPI

Stephanie Marie Gallagher, P.A.-C.

  • Medical Physician Assistant
  • Syracuse, NY
National Provider Identifier
1790152064
Registry record updated Jan 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
1000 E Genesee St Ste 300
Syracuse, NY 13210-1853
Phone
(315) 471-1044
NPI assigned
Aug 21, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2018

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 Primary

Addresses

Primary practice location

1000 E Genesee St Ste 300
Syracuse, NY 13210-1853

Mailing address

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

Other names 1

  • Miss Stephanie Marie Dussing Former name

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
I20151208002065 NY Practitioner - Physician Assistant 5799085189 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

4101 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 637-7878

4103 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 744-1500

4117 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 744-1551

5100 W Taft Rd
Liverpool, NY 13088-3807
Phone (315) 452-2828

5100 W Taft Rd
Liverpool, NY 13088-4841

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019231NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
North Medical PC Current Accepting new patients

Locations

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

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, 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": "1440115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517356800000",
    "number": "1790152064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E GENESEE ST STE 300",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-471-1044",
            "fax_number": "315-474-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E GENESEE ST STE 300",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101853",
            "telephone_number": "315-471-1044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLAGHER",
        "first_name": "STEPHANIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-21",
        "last_updated": "2018-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "DUSSING",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "P.A.-C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.