Deactivated NPI 1205920832 Deactivated / Inactive NPI Male Practitioner

Dr. William Glenn Patrick , MD

Specialist • Fayetteville, NY

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. William Patrick has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 03, 2006

NPI Deactivation Date February 22, 2021

Total Practice Duration ~15 Years of Practice (2006 – 2021)

Professional Overview & Biography Verified Profile Summary

Dr. William Patrick, MD was a registered Specialist practicing in Fayetteville, NY. Throughout an active medical career spanning 15 years, Dr. Patrick provided care at the practice location at 212 HIGHBRIDGE STREET until profile deactivation on 2021-02-22.

Historical Medicare Part B clinical services included destruction of precancer skin growth, established patient outpatient office visit, destruction of precancer skin growth, 2-14 growths. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

212 Highbridge Street
Suite A

Fayetteville, NY 13066

Telephone 3156379116

Fax 3156375224

Associated Practice Facility / Clinic

🏢 William G. Patrick, M.d., P.c. Facility NPI 1134274954

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Fayetteville, NY

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 10.5 Yrs

State Avg: 34.9 Yrs

Regional Practice Density

4 Specialists

Practicing in Fayetteville, NY (23296 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

29.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2020)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17004 Destruction of precancer skin growth, 15 or more growths	41	41	$210.00	$154.91
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	34	34	$157.00	$106.43
99213 Established patient office or other outpatient visit, typically 15 minutes	32	32	$107.13	$73.27

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,495	134	$8.02	$5.38
17004 Destruction of precancer skin growth, 15 or more growths	485	331	$210.47	$146.26
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	451	390	$158.38	$105.03
99213 Established patient office or other outpatient visit, typically 15 minutes	386	292	$106.56	$71.86
17000 Destruction of skin growth	167	138	$96.57	$62.21
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	80	32	$219.82	$73.46
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	48	44	$443.04	$270.84
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	39	39	$156.00	$105.07
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	30	23	$692.00	$443.29
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	28	21	$206.00	$94.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	23	22	$64.00	$43.78
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	20	17	$297.00	$174.67
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	20	19	$465.00	$170.62
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	18	17	$255.00	$157.03
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	15	13	$395.00	$140.70
Q0112 All potassium hydroxide (koh) preparations	14	14	$9.21	$5.30
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	11	11	$288.45	$94.16

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,159	213	$8.03	$4.94
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	526	473	$158.19	$102.64
17004 Destruction of precancer skin growth, 15 or more growths	516	374	$210.81	$137.98
99213 Established patient office or other outpatient visit, typically 15 minutes	469	360	$106.92	$69.37
17000 Destruction of skin growth	251	217	$96.64	$61.18
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	87	32	$220.52	$71.79
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	63	53	$444.63	$260.76
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	58	58	$156.91	$103.35
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	36	33	$65.17	$39.99
17110 Destruction of up to 14 skin growths	30	26	$163.00	$107.18
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	26	20	$465.00	$206.28
11100 Biopsy of single growth of skin and/or tissue	25	22	$153.00	$94.98
Q0112 All potassium hydroxide (koh) preparations	23	21	$9.13	$5.46
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	22	18	$206.00	$98.62
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	22	15	$175.00	$78.53
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	21	19	$259.05	$132.29
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	20	16	$715.00	$421.26
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	20	18	$164.75	$77.72
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	19	18	$297.00	$175.68
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	19	17	$443.05	$174.47
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	16	15	$211.00	$108.86
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	15	11	$278.00	$159.05
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	11	11	$413.00	$136.27

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,185	198	$11.05	$5.23
17004 Destruction of precancer skin growth, 15 or more growths	643	448	$180.98	$142.93
99213 Established patient office or other outpatient visit, typically 15 minutes	622	440	$108.85	$69.31
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	519	463	$159.20	$102.68
17000 Destruction of skin growth	248	204	$86.96	$61.40
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	97	97	$136.24	$102.97
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	59	30	$157.00	$71.07
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	54	45	$324.33	$267.92
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	44	27	$185.00	$132.85
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	34	27	$150.00	$105.63
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	30	29	$64.00	$41.68
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	27	25	$500.00	$446.67
Q0112 All potassium hydroxide (koh) preparations	25	23	$23.96	$5.51
11100 Biopsy of single growth of skin and/or tissue	25	22	$117.56	$96.63
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	22	20	$337.91	$173.74
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	21	19	$131.76	$79.61
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	19	12	$201.00	$163.19
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	14	12	$196.00	$145.91
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	14	11	$226.71	$181.45
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	13	11	$120.46	$73.51
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	12	11	$450.00	$356.82
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	12	11	$294.17	$140.48
17273 Destruction of malignant growth (2.1 to 3.0 centimeters) of scalp, neck, hands, feet, or genitals	11	11	$219.00	$189.49

Medical Specialties & State Licenses

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License NY 142578-1

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners

Michael Warren , MPAS, PA-C

Physician Assistant

NPI 1114329810

MPAS, Physician Assistant (Certified)

Dr. James Prezzano , MD

Dermatology

NPI 1538554753

Doctor of Medicine (M.D.)

Katharine Shields , FNP

Nurse Practitioner - Family

NPI 1588210850

Family Nurse Practitioner

Abigail Hunt Dugo , PA

Physician Assistant

NPI 1679279467

Physician Assistant

Daniel Green

Physician Assistant

NPI 1700288966

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events

⚠️

NPI Profile Deactivated February 22, 2021

Record deactivated on February 22, 2021

✅

NPI Profile Active October 15, 2011

NPI status registered as active in NPPES database

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Updated Practice Location October 15, 2011

Registered at 212 HIGHBRIDGE STREET, SUITE A, FAYETTEVILLE, NY 13066 (Tel: 3156379116)

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Updated Business Mailing Address October 15, 2011

Registered at 212 HIGHBRIDGE STREET, SUITE A, FAYETTEVILLE, NY 130661989 (Tel: 3156379116)

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Provider Name / Credentials Updated October 15, 2011

Recorded as WILLIAM PATRICK, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 15, 2011

Specialist (License #142578-1 in NY)

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Initial NPI Registration & Enumeration October 03, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1205920832

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 03, 2006

Last Update: October 15, 2011

Deactivation Date: February 22, 2021

Update or Correct Profile

Mailing Address

212 Highbridge Street, Suite A

Fayetteville, NY 130661989

Phone: 3156379116

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

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