Individual provider Active NPI

Ross Ryan Moquin, M.D.

  • Neurological Surgery Physician
  • Syracuse, NY
National Provider Identifier
1821093279
Registry record updated Mar 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
240707 Issued in NY
Practice address
739 Irving Ave Ste 600
Syracuse, NY 13210-1663
Phone
(315) 701-2550
Fax
(315) 701-2551
NPI assigned
Jun 14, 2005
Last updated
Mar 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 240707 NY Primary

Addresses

Primary practice location

739 Irving Ave Ste 600
Syracuse, NY 13210-1663

Mailing address

1001 W Fayette St
Suite 400
Syracuse, NY 13204-2859
Phone (315) 475-3999

Other practice location 1

475 Irving Ave
Suite 418
Syracuse, NY 13210-1756
Phone (315) 475-3999

Other identifiers 1

IdentifierTypeStateIssuer
02809254MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rmoquin@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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070117000303 NY Practitioner - Neurosurgery 2264430107 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Neurosurgical Associates of Central New York, LLP CurrentSince Oct 1, 2006 Accepting new patients
Upstate Neurosurgery LLP Neurological Surgery CurrentSince Oct 1, 2006 Accepting new patients
Guy W. Gargour, M.D., P.a. Neurological Surgery Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Crouse Medical Practice PLLC Past Accepting new patients
Guy W. Gargour, M.D., P.a. Neurological Surgery Past Accepting new patients

Locations

4900 Broad Rd
Ste 1352
Syracuse, NY 13215
Phone (315) 464-4470

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.

NPI Registry JSON

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1821093279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST",
            "address_2": "SUITE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042859",
            "telephone_number": "315-475-3999",
            "fax_number": "315-470-4014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 IRVING AVE STE 600",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101663",
            "telephone_number": "315-701-2550",
            "fax_number": "315-701-2551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Irving Ave",
            "address_2": "Suite 418",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132101756",
            "country_code": "US",
            "telephone_number": "315-475-3999",
            "fax_number": "315-470-4014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOQUIN",
        "first_name": "ROSS",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NY",
            "license": "240707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02809254",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rmoquin@crousemed.medentdirect.com",
            "affiliation": "Y",
            "endpointDescription": "email address in Medent",
            "affiliationName": "Crouse Medical Practice, PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "739 Irving Ave Ste 600",
            "city": "Syracuse",
            "state": "NY",
            "country_code": "US",
            "postal_code": "132101663",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.