NPIMap

Organization Active NPI

Psychiatry Faculty Practice, Inc.

  • Psychiatry Physician
  • Syracuse, NY
National Provider Identifier
1881084820
Registry record updated Jan 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PSYCHIATRY FACULTY PRACTICE, INC.
Practice address
713 Harrison St
Syracuse, NY 13210-2305
Phone
(315) 464-3119
Fax
(315) 464-3282
NPI assigned
Jan 29, 2015
Last updated
Jan 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2015

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

Authorized official

Name
Barbara A Svoboda
Title
Practice Plan Administrator
Phone
(315) 464-3119

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

713 Harrison St
Syracuse, NY 13210-2305

Mailing address

713 Harrison St
Syracuse, NY 13210-2305
Phone (315) 464-3119

Other identifiers 1

IdentifierTypeStateIssuer
00570654MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150508000699 NY Part B Supplier - Clinic/Group Practice 9234458530 Receives reassigned benefits from 169 practitioners
Practice locations: Syracuse, NY

National Provider Directory

National Provider Directory

Locations

600 E Genesee St
Ste 108
Syracuse, NY 13202
Phone (315) 422-6353

713 Harrison St
#3
Syracuse, NY 13210
Phone (315) 464-3119

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

713 Harrison St
Bldg Tu
Syracuse, NY 13210

713 Harrison St
Ste TU3
Syracuse, NY 13210

719 Harrison St
Syracuse, NY 13210
Phone (315) 464-3265

Practitioners & affiliated clinicians

Practitioners 212

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 212

NPI Registry JSON

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

{
    "created_epoch": "1422489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1881084820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 HARRISON ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102305",
            "telephone_number": "315-464-3119",
            "fax_number": "315-464-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 HARRISON ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102305",
            "telephone_number": "315-464-3119",
            "fax_number": "315-464-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRY FACULTY PRACTICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-29",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "SVOBODA",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE PLAN ADMINISTRATOR",
        "authorized_official_telephone_number": "315-464-3119"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00570654",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; 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.