Derek Robert Cooney, MD is a medicare enrolled "Pain Medicine - Pain Medicine" physician in East Syracuse, New York. His current practice location is
6620 Fly Rd Ste 205, East Syracuse, New York. You can reach out to his office (for appointments etc.) via phone at
(315) 464-4259.
Derek Robert Cooney is licensed to practice in New York (license number 243861) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1811959612.
Physician's Profile
| Full Name | Derek Robert Cooney |
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| Gender | Male |
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| Speciality | Pain Medicine - Pain Medicine |
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| Location | 6620 Fly Rd Ste 205, East Syracuse, New York |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1811959612
- Provider Enumeration Date: 04/05/2006
- Last Update Date: 06/09/2026
Medicare PECOS Information:
- PECOS PAC ID: 9830138106
- Enrollment ID: I20071015000527
Medical Identifiers
Medical identifiers for Derek Robert Cooney such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1811959612 | NPI | - | NPPES |
| 1721391-01 | Medicaid | TX | |
| 8P9119 | Other | TX | BLUE SHIELD |
| 02881712 | Medicaid | NY | |
| 1721391-02 | Other | TX | CSHCN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207P00000X | Emergency Medicine | M0691 (Texas) | Secondary |
| 207P00000X | Emergency Medicine | 243861 (New York) | Secondary |
| 208VP0000X | Pain Medicine - Pain Medicine | 243861 (New York) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Derek Robert Cooney allows following entities to bill medicare on his behalf.
| Entity Name | Department Of Medicine Medical Serv Grp At Suny Hlth Sci Ctr Syr In |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1063468239
PECOS PAC ID: 3274445796
Enrollment ID: O20031104000051 |
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| Entity Name | Upstate Emergency Medicine, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1275589582
PECOS PAC ID: 2466443494
Enrollment ID: O20040519001106 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Derek Robert Cooney is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Derek Robert Cooney, MD
5784 Widewaters Pkwy Ste 2,
Syracuse, NY 13214-1890
Ph: (315) 469-1130 | Derek Robert Cooney, MD
6620 Fly Rd Ste 205,
East Syracuse, NY 13057-4282
Ph: (315) 464-4259 |
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