Individual provider Active NPI

Bryan Masterson, PA-C

  • Physician Assistant
  • Syracuse, NY
National Provider Identifier
1992019962
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014921 Issued in NY
Practice address
5719 Widewaters Pkwy Ste 2
Syracuse, NY 13214-1877
Phone
(315) 251-3100
NPI assigned
Aug 2, 2010
Last updated
Aug 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 002424 CT
Physician Assistant 363A00000X 014921 NY Primary

Addresses

Primary practice location

5719 Widewaters Pkwy Ste 2
Syracuse, NY 13214-1877

Mailing address

5719 Widewaters Pkwy
Syracuse, NY 13214-1985
Phone (315) 251-3100

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110909002443 NY Practitioner - Physician Assistant 9133309057 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upstate Community Medical, PCGroup PAC ID 0143238782, 153 clinicians

Practice addresses (Care Compare)

301 Prospect Ave
Syracuse, NY 13203-1807
Phone (315) 448-5111

415 E 37TH St
Apt 21a
New York, NY 10016-3243
Phone (313) 525-1310

4900 Broad Rd
Syracuse, NY 13215-2265

5719 Widewaters Pkwy
Syracuse, NY 13214-1985
Phone (315) 251-3100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
014921NYMDMental Health Counselor
002424CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Syracuse Orthopedic Specialists, PLLC CurrentSince Sep 1, 2011 Accepting new patients
North Medical PC Current Accepting new patients

Locations

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

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

301 Prospect Ave
Ofc
Syracuse, NY 13203
Phone (315) 448-2876

4900 Broad Rd
Ste 4H
Syracuse, NY 13215
Phone (315) 492-5678

5719 Widewaters Pkwy
Syracuse, NY 13214
Phone (315) 251-3110

5719 Widewaters Pkwy
Ste 2
Syracuse, NY 13214
Phone (315) 544-3380

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1992019962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5719 WIDEWATERS PKWY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141985",
            "telephone_number": "315-251-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5719 WIDEWATERS PKWY STE 2",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141877",
            "telephone_number": "315-251-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTERSON",
        "first_name": "BRYAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-02",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "002424",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.