Buffalo Ultrasound, Idtf

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

BUFFALO ULTRASOUND, IDTF

Practice address

388 Evans St
Williamsville, NY 14221-5626

Phone

(716) 631-2262

Fax

(716) 631-8237

NPI assigned

Oct 7, 2008

Last updated

Apr 15, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Straeck Jr.

Title

President

Phone

(716) 631-2262

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013168194. Details of each certification follow.

• CCN 33X0009874 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 33X0009874

Legal name

CLOSED -- BUFFALO ULTRASOUND, INCORPORAT

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Mar 25, 1995

Last certification

Dec 18, 2014

Ownership / control type

CORPORATION

Facility address

388 Evans Street 2ND FL
Williamsville, NY 14221

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Buffalo Ultrasound, Idtf Inc

  • Physiological Laboratory
  • Williamsville, NY
  • NPI 1790892826

  7416058748

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Buffalo Ultrasound, Idtf Inc

  • Physiological Laboratory
  • Williamsville, NY
  • NPI 1790892826

  O20070731000050

  Same enrollment

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Keith Brooks

  • Diagnostic Radiology Physician
  • Boston, MA
  • NPI 1457470247
  NPD (past)

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1013168194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "388 EVANS ST",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142215626",
            "telephone_number": "716-631-2262",
            "fax_number": "716-631-8237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "388 EVANS ST",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142215626",
            "telephone_number": "716-631-2262",
            "fax_number": "716-631-8237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUFFALO ULTRASOUND, IDTF",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A",
        "authorized_official_last_name": "STRAECK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-631-2262",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02405181",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Williamsville, NY
• Providers in Williamsville, NY by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.