NPIMap

Individual provider Active NPI

Marzella J Harrison, RPA

  • Physician Assistant
  • Houghton, NY
National Provider Identifier
1972718765
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
011156 Issued in NY
Practice address
9864 Luckey Dr
Houghton, NY 14744-8706
Phone
(716) 375-7500
Fax
(716) 701-6853
NPI assigned
May 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 011156 NY Primary

Addresses

Primary practice location

9864 Luckey Dr
Houghton, NY 14744-8706

Mailing address

135 N Union St
Olean, NY 14760-2736
Phone (716) 375-7500

Other identifiers 1

IdentifierTypeStateIssuer
01357340MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071010000088 NY Practitioner - Physician Assistant 6305932146 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

140 W Main St
Suite 1
Cuba, NY 14727-1317
Phone 71637575006879

9864 Luckey Dr
Houghton, NY 14744-8706
Phone 71637575006879

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
011156NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Jan 11, 2017 Accepting new patients
Southern Tier Community Health Center Network, Inc. CurrentSince Sep 1, 2019 Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. CurrentSince Jan 11, 2017 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. Physician Assistant Current Accepting new patients
Southern Tier Community Health Center Network, Inc. CurrentSince Sep 1, 2019 Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

169 Riverside Dr
#L
Binghamton, NY 13905
Phone (607) 798-5474

132 W Main St
Cuba, NY 14727

415 Hooper Rd
Endwell, NY 13760
Phone (607) 754-3863

9864 Luckey Dr
Houghton, NY 14744

135 N Union St
Olean, NY 14760

500 Main St
Olean, NY 14760
Phone (716) 373-2600

500 5th Ave
Owego, NY 13827
Phone (607) 687-1122

Interoperability endpoints

  • Direct secure messaging: marzella.harrison@sthc.eclinicaldirectplus.com

Organizations & group practices 6

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 6

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": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1972718765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N UNION ST",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147602736",
            "telephone_number": "716-375-7500",
            "fax_number": "716-701-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9864 LUCKEY DR",
            "city": "HOUGHTON",
            "state": "NY",
            "postal_code": "147448706",
            "telephone_number": "716-375-7500",
            "fax_number": "716-701-6853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "MARZELLA",
        "middle_name": "J",
        "credential": "RPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01357340",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houghton, NY

Sources for this page

Verify at the official NPI Registry.