FAMILYCARE MEDICAL GROUP, PC (NPI# 1447212063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447212063 |
| Entity Type | Organization |
| Organization Name | FAMILYCARE MEDICAL GROUP, PC |
| Practice Address |
1001 W Fayette St Ste 400 Syracuse NY 13204-2859 |
| Practice Telephone | 3154721488 |
| Practice Fax Number | 3158835405 |
| Mailing Telephone | 3154721488 |
| Mailing Fax Number | 3158835405 |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2013-03-11 |
| Authorized Official Name | MITCHELL V BRODEY (PRESIDENT) |
| Authorized Official Telephone | 3154925784 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 291U00000X | Clinical Medical Laboratory | Laboratories | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03459574 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447539853 | Familycare Medical Group, PC | Clinical Medical Laboratory | 810 S 1st St, Fulton, NY 13069-4902 | 2011-08-16 |
| Street Address |
1001 W FAYETTE ST STE 400 |
| City | SYRACUSE |
| State | NY |
| Zip Code | 13204-2859 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588669964 | Barbara Clayton | Internal Medicine | 1001 W Fayette St, Suite 400, Syracuse, NY 13204-2859 | 2005-06-14 |
| 1568901007 | Corissa Tefft | Physician Assistant | 1001 W Fayette St, Suite 400, Syracuse, NY 13204-2859 | 2017-02-16 |
| 1770893034 | Shannon Lynn Moynihan | Physician Assistant | 1001 W Fayette St, Suite 400, Syracuse, NY 13204-2859 | 2010-10-20 |
| 1780689091 | Louis Mayer Green | Internal Medicine | 1001 W Fayette St, Suite 400, Syracuse, NY 13204-2859 | 2005-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560145 | Angela Hester | Psychologist | Behavioral Health Outpatient Clinic, 620 Erie Blvd West, Syracuse, NY 13204 | 2020-08-24 |
| 1366967366 | Zakiya Folami Moss | Nurse Practitioner | 321 Gifford Street, Syracuse, NY 13204 | 2017-08-10 |
| 1417350497 | Vickie Godbold | Licensed Practical Nurse | 501 Bellevue Ave, Syracuse, NY 13204 | 2014-10-03 |
| 1700296571 | Christine Michelle Feliciano | Licensed Practical Nurse | 206 Merriman Ave, Syracuse, NY 13204 | 2014-05-02 |
| 1215358213 | Mika Latoy Johnson | Licensed Practical Nurse | 197 Lakeview Ave, Syracuse, NY 13204 | 2013-12-18 |
| 1376834374 | Autumn Day Novakowski | Registered Nurse | 800 S. Wilbur Ave, Syracuse, NY 13204 | 2011-04-25 |
| 1649580440 | Elizabeth Elliott Carl | Speech-Language Pathologist | 204 Jamesville Road, Dewitt, NY 13204 | 2010-10-14 |
| 1699082073 | Charlene Davis | Licensed Practical Nurse | 183 Lakeview Ave., Syr, NY 13204 | 2010-09-08 |
| 1477873776 | Lorna Cordella Forbes | Registered Nurse | 620 Erie Blvd W Ste 208, Syracuse, NY 13204 | 2010-06-09 |
| 1043442528 | Juliet Ophelia Williams-seals | Licensed Practical Nurse | 525 Plum St, Apt 404, Syracuse, NY 13204 | 2009-08-17 |
| Find all providers in zip 13204 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104451848 | Gianna of Syracuse Medical Pllc | Family Medicine | 127 Chapel Dr., Syracuse, NY 13219-1919 | 2020-03-03 |
| 1235616210 | Shelby Lynn Sharp | Family Medicine | 90 Presidential Plz Ste 5010, Syracuse, NY 13202-2240 | 2018-07-23 |
| 1245471705 | Ihc Health Services Inc | Family Medicine | 745 South 2000 West, Syracuse, UT 84075 | 2009-03-13 |
| 1891932596 | Marc Iqbal | Family Medicine | 5606 Bear Rd, Syracuse, NY 13212-1648 | 2009-01-16 |
| 1205073483 | Paul Peter Stobnicke | Family Medicine | 504 Winkworth Pkwy, Syracuse, NY 13215-1554 | 2009-01-09 |
| 1700070216 | Douglas Ahn Md Pllc | Family Medicine | 739 Irving Ave Ste 510, Syracuse, NY 13210-1663 | 2007-08-29 |
| 1114133402 | Maryellen Cathleen Lewis | Family Medicine | 216 Seymour St, Syracuse, NY 13204-3208 | 2007-05-15 |
| 1346320140 | Jack Prow Clark | Family Medicine | 518 Ems D15 Ln, Syracuse, IN 46567-8026 | 2006-10-16 |
| 1457445744 | Frank Raymond Sharf | Family Medicine | 745 S 2000 W, Syracuse, UT 84075-9621 | 2006-10-03 |
| 1740392927 | Warsaw Health System, LLC | Family Medicine | 808 S Huntington St, Syracuse, IN 46567-1810 | 2006-08-31 |
| Find all providers in SYRACUSE | ||||
Please comment or provide details below to improve the information on FAMILYCARE MEDICAL GROUP, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.