NPIMap

Individual provider Active NPI

Michael James Fennell II, PA-C

  • Physician Assistant
  • Orchard Park, NY
National Provider Identifier
1023765708
Registry record updated Mar 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
028057-01 Issued in NY
Practice address
3055 Southwestern Blvd Ste 100
Orchard Park, NY 14127-1231
Phone
(716) 675-2500
NPI assigned
Mar 3, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 028057-01 NY Primary

Addresses

Primary practice location

3055 Southwestern Blvd Ste 100
Orchard Park, NY 14127-1231

Mailing address

9673 Garden Walk
Clarence Center, NY 14032-9411

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
I20220502002203 NY Practitioner - Physician Assistant 7517354004 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3055 Southwestern Blvd
Suite 100
Orchard Park, NY 14127-1231
Phone (716) 675-2500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
028057-01NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Buffalo Rheumatology and Medicine PLLC CurrentSince Apr 11, 2022 Accepting new patients

Locations

3500 Sheridan Dr
Buffalo, NY 14226
Phone (716) 204-4263

3055 Southwestern Blvd
Ste 100
Orchard Park, NY 14127
Phone (716) 675-2500

Interoperability endpoints

  • Direct secure messaging: mfennell@buffalorheumatology.medentdirect.com

Organizations & group practices 1

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

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1023765708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9673 GARDEN WALK",
            "city": "CLARENCE CENTER",
            "state": "NY",
            "postal_code": "140329411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 SOUTHWESTERN BLVD STE 100",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271231",
            "telephone_number": "716-675-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNELL",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-03",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "028057-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orchard Park, NY

Sources for this page

Verify at the official NPI Registry.