NPIMap

Individual provider Active NPI

Dale W Sponaugle, MD

  • Diagnostic Radiology Physician
  • Medina, NY
National Provider Identifier
1023018462
Registry record updated Aug 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
164356 Issued in NY
Practice address
200 Ohio St
Medina, NY 14103-1063
Phone
(585) 798-8054
Fax
(585) 798-8150
NPI assigned
Jul 28, 2005
Last updated
Aug 30, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 164356 NY Primary

Addresses

Primary practice location

200 Ohio St
Medina, NY 14103-1063

Mailing address

275 Northpointe Pkwy
Ste 50
Amherst, NY 14228-1895
Phone (716) 692-2160

Other identifiers 10

IdentifierTypeStateIssuer
01257134MedicaidNY
020382600OtherFEDERAL BLACK LUNG
117837FFOtherNYPREFERRED CARE
040403006845OtherNYFIDELIS CARE NEW YORK
P010164356OtherNYROCHESTER BCBS
00020548502OtherNYUNIVERA HEALTHCARE
5690902OtherNYINDEPENDENT HEALTH
000525331009OtherNYBCBS WNY
164356OtherNYWORKERS COMPENSATION
201590500OtherFEDERAL WORKERS COMP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040911000213 NY Practitioner - Diagnostic Radiology 1355318221 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
State University of New York at Buffalo School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orleans Community HealthGroup PAC ID 7315857018, 20 clinicians

Practice addresses (Care Compare)

200 Ohio St
Medina, NY 14103-1063
Phone (716) 798-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
164356NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orleans Community Health CurrentSince Apr 1, 2016 Accepting new patients
Orleans Community Health CurrentSince Jan 1, 2022 Accepting new patients
Orleans Community Health Current Accepting new patients
Sleep Insights Medical Services, LLC PastSince Dec 1, 2015 Accepting new patients
Olean Open MRI PC Diagnostic Radiology Past Accepting new patients

Locations

200 Ohio St
Medina, NY 14103
Phone (585) 798-2000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22039/brand/2/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medina Memorial HospitalMedina, NY, CCN 331319 Hospital Corporate Director Aug 27, 2014
Medina Memorial HospitalMedina, NY, CCN 33Z319 Hospital Corporate Director Apr 1, 2016
Orleans Community HealthMedina, NY, CCN 335313 Skilled nursing facility Corporate Officer Apr 1, 2016
Orleans Community HealthAlbion, NY, CCN 333975 Rural health clinic Corporate Director Aug 27, 2014

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504051200000",
    "number": "1023018462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 NORTHPOINTE PKWY",
            "address_2": "STE 50",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142281895",
            "telephone_number": "716-692-2160",
            "fax_number": "716-692-4342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 OHIO ST",
            "city": "MEDINA",
            "state": "NY",
            "postal_code": "141031063",
            "telephone_number": "585-798-8054",
            "fax_number": "585-798-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPONAUGLE",
        "first_name": "DALE",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2017-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "164356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01257134",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "020382600",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "117837FF",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS CARE NEW YORK",
            "identifier": "040403006845",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ROCHESTER BCBS",
            "identifier": "P010164356",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA HEALTHCARE",
            "identifier": "00020548502",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "5690902",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS WNY",
            "identifier": "000525331009",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "164356",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL WORKERS COMP",
            "identifier": "201590500",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, NY

Sources for this page

Verify at the official NPI Registry.