Individual provider Active NPI

Nicolas Pauly, NPP

  • Psychiatric/Mental Health Nurse Practitioner
  • Fayetteville, NY
National Provider Identifier
1790192508
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
401735 Issued in NY
Practice address
6836 E Genesee St
Fayetteville, NY 13066-1024
Phone
(315) 446-1435
NPI assigned
Jul 14, 2014
Last updated
Jul 14, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 401735 NY Primary

Addresses

Primary practice location

6836 E Genesee St
Fayetteville, NY 13066-1024

Mailing address

6836 E Genesee St
Fayetteville, NY 13066-1024

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
I20160210002435 NY Practitioner - Nurse Practitioner 8527362631 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
May accept Medicare assignment
Group practices
Psychiatry Faculty Practice, IncGroup PAC ID 9234458530, 90 clinicians
Psychiatric NP Consultants of Central New York, PLLCGroup PAC ID 6709143191, 7 clinicians

Practice addresses (Care Compare)

4900 Broad Rd
Syracuse, NY 13215-2265
Phone (315) 464-3265

4914 W Genesee St
Suite 121
Camillus, NY 13031-2378
Phone (315) 446-1435

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.28 of 100Reported as group
Quality
88.2
Promoting interoperability
100
Improvement activities
40
Cost
69.72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
401735NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Auburn Memorial Medical Services, PC CurrentSince Apr 20, 2020 Accepting new patients
Psychiatric NP Consultants of Central New York, PLLC Psychiatric/Mental Health CurrentSince Jul 1, 2022 Accepting new patients
Auburn Memorial Medical Services, PC CurrentSince Apr 20, 2020 Accepting new patients
Upstate Community Medical, PC CurrentSince Feb 1, 2016 Accepting new patients
Psychiatry Faculty Practice, Inc. CurrentSince Jul 1, 2023 Accepting new patients

Locations

17 Lansing St
Ste 201
Auburn, NY 13021
Phone (315) 252-7434

77 Nelson St
Ste 120
Auburn, NY 13021
Phone (315) 252-7550

17 Lansing St
Sennett, NY 13021
Phone (315) 255-7011

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

4900 Broad Rd
Syracuse, NY 13215
Phone (315) 492-5011

4900 Broad Rd
Ste 4H
Syracuse, NY 13215
Phone (315) 492-5678

713 Harrison St
Bldg 3
Syracuse, NY 13210
Phone (315) 464-3265

Interoperability endpoints

  • Direct secure messaging: npauly26396@direct.upstate.edu

Organizations & group practices 6

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 1

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": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1790192508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6836 E GENESEE ST",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6836 E GENESEE ST",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661024",
            "telephone_number": "315-446-1435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULY",
        "first_name": "NICOLAS",
        "credential": "NPP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-14",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "401735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NY

Sources for this page

Verify at the official NPI Registry.