Active NPI
Gerald Allen Willsey, PA
- General Acute Care Hospital
- Syracuse, NY
National Provider Identifier
1881808459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Acute Care Hospital
- License
- 000345-1
- Practice address
- 736 Irving Ave
Emergency Services Office
Syracuse, NY 13210-1687 - Phone
- (315) 470-7308
- Fax
- (315) 470-2693
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 000345-1 | NY | Primary |
Addresses
Primary practice location
736 Irving Ave
Emergency Services Office
Syracuse, NY 13210-1687
Mailing address
4159 Griffin Rd
Syracuse, NY 13215-9718
Phone (315) 575-1936
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000345-1 | Other | NY | REGISTRATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000345-1 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881808459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4159 GRIFFIN RD",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132159718",
"telephone_number": "315-575-1936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "736 IRVING AVE",
"address_2": "EMERGENCY SERVICES OFFICE",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132101687",
"telephone_number": "315-470-7308",
"fax_number": "315-470-2693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLSEY",
"first_name": "GERALD",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "282N00000X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital",
"state": "NY",
"license": "000345-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTRATION",
"identifier": "000345-1",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.