Individual provider Active NPI

Michael P Sharak, PA

  • Medical Physician Assistant
  • Syracuse, NY
National Provider Identifier
1992702278
Registry record updated Jun 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
000439 Issued in NY
Practice address
90 Presidential PLZ
Firm B
Syracuse, NY 13202-2240
Phone
(315) 464-5412
NPI assigned
Jul 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 000439 NY Primary

Addresses

Primary practice location

90 Presidential PLZ
Firm B
Syracuse, NY 13202-2240

Mailing address

750 E Adams St
Syracuse, NY 13210-2306

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
I20050208000074 NY Practitioner - Physician Assistant 2365409968 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000439NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Associates of Syracuse, PC Current Accepting new patients
Crouse Health Hospital Inc CurrentSince Aug 8, 2004 Accepting new patients
Suny Health Science Center at Syracuse Medical CurrentSince Mar 28, 1990 Accepting new patients
Suny Health Science Center at Syracuse CurrentSince Mar 28, 1990 Accepting new patients
Department of Medicine Medical Service Group Past Accepting new patients

Locations

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

90 Presidential Plz
#B
Syracuse, NY 13202
Phone (315) 464-5240

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

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

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245628800000",
    "number": "1992702278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 PRESIDENTIAL PLZ",
            "address_2": "FIRM B",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132022240",
            "telephone_number": "315-464-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARAK",
        "first_name": "MICHAEL",
        "middle_name": "P",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2009-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "000439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.