NPIMap

Organization Active NPI

Camillus Anesthesia PLLC

  • Anesthesiology Physician
  • Camillus, NY
National Provider Identifier
1801476411
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
CAMILLUS ANESTHESIA PLLC
Practice address
5700 W Genesee St Ste 11
Camillus, NY 13031-3205
Phone
(315) 701-9378
NPI assigned
Apr 9, 2021
Last updated
Mar 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Authorized official

Name
Jacob Thomas, MDNPI 1063418440
Title
Owner
Phone
(315) 449-0513

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

5700 W Genesee St Ste 11
Camillus, NY 13031-3205

Mailing address

PO Box 2005
East Syracuse, NY 13057-4505
Phone (315) 449-0513

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210609003224 NY Part B Supplier - Clinic/Group Practice 5890195010 Receives reassigned benefits from 23 practitioners
Practice locations: Syracuse, NY; East Syracuse, NY; Camillus, NY; Auburn, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1801476411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2005",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574505",
            "telephone_number": "315-449-0513",
            "fax_number": "315-362-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 W GENESEE ST STE 11",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130313205",
            "telephone_number": "315-701-9378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMILLUS ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-09",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-449-0513",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camillus, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.