1500 GRANT BLVD DENTISTRY, PLLC — NPI 1497263685 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in SYRACUSE, NY)

CMS-1500 Box 24J / 33a • NPI

1497263685

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QD0000X

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

1500 GRANT BLVD, SYRACUSE, NY, 13208-3014

✓ 9-Digit EDI 837 ZIP+4 (13208-3014)

Practice Phone & Referral Fax

(315) 472-3414

Fax: (315) 472-4320

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1497263685 (1500 GRANT BLVD DENTISTRY, PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1497263685` (NPI-2 Organization / Facility)
Provider / Legal Name	1500 GRANT BLVD DENTISTRY, PLLC
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QD0000X` (Clinic/Center, Dental)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	1500 GRANT BLVD, SYRACUSE, NY, 13208-3014
Practice Telephone / Fax	Tel: (315) 472-3414 \| Fax: (315) 472-4320
Administrative Mailing Address	1500 GRANT BLVD, SYRACUSE, NY, 13208-3014
Enumeration & Last Sync	Enumerated: 2018-01-22 \| CMS Record Updated: 2018-01-22
Authorized Official	ARUN BALAKUMAR (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1500 GRANT BLVD, SYRACUSE, NY, 13208-3014

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Plain-English Taxonomy & CMS Crosswalk (261QD0000X)

What Does Taxonomy Code 261QD0000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QD0000X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (1500 GRANT BLVD DENTISTRY, PLLC)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QD0000X` — Clinic/Center, Dental Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: NY \| License: `051141` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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1500 GRANT BLVD DENTISTRY, PLLC (NPI #1497263685)