Organization Active NPI

Jana Dosztan-Reiss, Inc.

  • Adult Health Nurse Practitioner
  • Liverpool, NY
National Provider Identifier
1962925495
Registry record updated Jul 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F302363-1 Issued in NY
Legal business name
JANA DOSZTAN-REISS, INC.
Practice address
4800 Bear Rd
Liverpool, NY 13088-4604
Phone
(315) 457-9946
NPI assigned
Jul 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2017

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

Authorized official

Name
Paul Mogren
Title
Practice Administrator
Phone
(315) 391-6645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X F302363-1 NY Primary

Addresses

Primary practice location

4800 Bear Rd
Liverpool, NY 13088-4604

Mailing address

PO Box 152
Skaneateles, NY 13152-0152
Phone (315) 391-6645

Other identifiers 1

IdentifierTypeStateIssuer
03171840MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170919002287 NY Part B Supplier - Clinic/Group Practice 0345514030 Receives reassigned benefits from 1 practitioner
Practice locations: Liverpool, NY; Syracuse, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500249600000",
    "number": "1962925495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 152",
            "city": "SKANEATELES",
            "state": "NY",
            "postal_code": "131520152",
            "telephone_number": "315-391-6645",
            "fax_number": "866-581-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 BEAR RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130884604",
            "telephone_number": "315-457-9946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANA DOSZTAN-REISS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-17",
        "last_updated": "2017-07-17",
        "status": "A",
        "authorized_official_last_name": "MOGREN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "315-391-6645"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F302363-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03171840",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2017; 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.