Individual provider Active NPI

Sean Bresnahan, DO

  • General Practice Physician
  • Syracuse, NY
National Provider Identifier
1902245384
Registry record updated Aug 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
285380 Issued in NY
Practice address
182 Intrepid LN
Syracuse, NY 13205-2545
Phone
(315) 218-7020
NPI assigned
Jun 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 285380 NY Primary

Addresses

Primary practice location

182 Intrepid LN
Syracuse, NY 13205-2545

Mailing address

182 Intrepid LN
Syracuse, NY 13205-2545
Phone (315) 218-7020

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
I20160916002061 NY Practitioner - Family Practice 9032406152 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Familycare Medical Group PCGroup PAC ID 5193639565, 110 clinicians

Practice addresses (Care Compare)

182 Intrepid LN
Syracuse, NY 13205-2545
Phone (315) 218-7020

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Liverpool, NY, CCN 337255
  • Hospice of Central New York Hospice, Liverpool, NY, CCN 331511
  • University Hospital S U N Y Health Science Center Hospital, Syracuse, NY, CCN 330241
  • St Joseph'S Hospital Health Center Hospital, Syracuse, NY, CCN 330140

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
285380NYMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Familycare Medical Group, PC CurrentSince Sep 1, 2016 Accepting new patients
North Medical PC Current Accepting new patients
St Josephs Medical PC CurrentSince Mar 30, 2020 Accepting new patients

Locations

4820 W Taft Rd
Ste 108
Liverpool, NY 13088
Phone (315) 413-0004

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

104 Union Ave
Syracuse, NY 13203
Phone (315) 422-4442

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

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

182 Intrepid Ln
Syracuse, NY 13205
Phone (315) 218-7020

Interoperability endpoints

  • Direct secure messaging: sbresnahan@fcmg.medentdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1902245384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 INTREPID LN",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132052545",
            "telephone_number": "315-218-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 INTREPID LN",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132052545",
            "telephone_number": "315-218-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRESNAHAN",
        "first_name": "SEAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-19",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "285380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.