NPIMap

Organization Active NPI

Upstate University Radiation Oncology, Inc.

  • Radiation Oncology Physician
  • Syracuse, NY
National Provider Identifier
1922337195
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
UPSTATE UNIVERSITY RADIATION ONCOLOGY, INC.
Practice address
750 E Adams St # 1064
Syracuse, NY 13210-2306
Phone
(315) 464-2020
Fax
(315) 464-2025
NPI assigned
Dec 16, 2009
Last updated
Jan 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Authorized official

Name
Mr. Jeffrey Buckman
Title
Practice Administrator
Phone
(315) 464-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X NU Primary

Addresses

Primary practice location

750 E Adams St # 1064
Syracuse, NY 13210-2306

Mailing address

750 E Adams St # 1064
Syracuse, NY 13210-2306
Phone (315) 464-2020

Other identifiers 1

IdentifierTypeStateIssuer
03236495MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100315000243 NY Part B Supplier - Clinic/Group Practice 7719012889 Receives reassigned benefits from 18 practitioners
Practice locations: Oswego, NY; Syracuse, NY; Verona, NY

National Provider Directory

National Provider Directory

Locations

224 Harrison St
Ste 600
Syracuse, NY 13202

750 E Adams St
#1064
Syracuse, NY 13210
Phone (315) 464-2020

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1260921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610409600000",
    "number": "1922337195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST # 1064",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST # 1064",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-464-2020",
            "fax_number": "315-464-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE UNIVERSITY RADIATION ONCOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-16",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A",
        "authorized_official_last_name": "BUCKMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "315-464-2020",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03236495",
            "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 12, 2021; 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.