Justin P Fedor, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

265947 Issued in NY

Practice address

5586 Legionnaire Dr Ste 1
Cicero, NY 13039-3504

Phone

(315) 699-2837

Fax

(315) 699-2734

NPI assigned

Jun 11, 2009

Last updated

Sep 19, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Family Practice

Education

New York College of Osteo Medicine of New York Institute of Technology, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Port City Emergency Physicians LLPGroup PAC ID 0345301917, 46 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Liverpool, NY, CCN 337255
• Oswego Hospital Hospital, Oswego, NY, CCN 330218

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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

• Port City Emergency Physicians LLP

  • Emergency Medicine Physician
  • Oswego, NY
  • NPI 1134370547
  Medicare reassignment Care Compare group NPD
• Cma Medical Practice PLLC

  dba Emergency Medicine Associates of Cayuga PLLC

  • Emergency Medicine Physician
  • Ithaca, NY
  • NPI 1962985564
  Medicare reassignment NPD
• St Josephs Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1942501747
  Medicare reassignment NPD
• North Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1972563070
  NPD
• Port City Emergency Physicians LLP

  • Emergency Medicine Physician
  • Hamilton, NY
  • NPI 1316395460
  NPD
• Port City Emergency Physicians LLP

  • Emergency Medicine Physician
  • Central Square, NY
  • NPI 1669721296
  NPD
• Cardiovascular Specialists PC

  dba New York Heart Center

  • Cardiovascular Disease Physician
  • Syracuse, NY
  • NPI 1710974613
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Oswego Hospital

  • General Acute Care Hospital
  • Oswego, NY
  • NPI 1871678458
  Care Compare affiliation
• QC-Medi New York, Inc.

  dba CenterWell Home Health

  • Home Health Agency
  • Syracuse, NY
  • NPI 1912939489
  Care Compare affiliation

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

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1982831483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5586 LEGIONNAIRE DR STE 1",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130393504",
            "telephone_number": "315-699-2837",
            "fax_number": "315-699-2734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5586 LEGIONNAIRE DR STE 1",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130393504",
            "telephone_number": "315-699-2837",
            "fax_number": "315-699-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDOR",
        "first_name": "JUSTIN",
        "middle_name": "P",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-11",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "265947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "265947",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Marlene Elkins
• Brianna Ellingworth, LMHC-D
• Empire Vision Center, Inc (Visionworks)
• Expressmart
• Family Medicine Associates of Central New York, P.C.
• Angela Marie Fisher
• Abigail R Fitzgerald, FNP
• Emily Caitlin Foor
• Thomas Anthony Forleo, RPH
• Jennifer Lynn Frank, RN IBCLC

• Family Medicine Physician in Cicero, NY
• Providers in Cicero, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.