NPIMap

Organization Active NPI

Upmc Chautauqua at Wca

Doing business as UPMC Chautauqua WCA

  • Hospitalist Physician
  • Jamestown, NY
National Provider Identifier
1033227111
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
UPMC CHAUTAUQUA AT WCA
Doing business as
UPMC Chautauqua WCA
Practice address
207 Foote Ave
Jamestown, NY 14701-7077
Phone
(716) 487-0141
NPI assigned
Aug 28, 2006
Last updated
Oct 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2020

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

Authorized official

Name
Brian Durniok
Title
Ceo
Phone
(814) 676-7146

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X
Vascular & Interventional Radiology Physician 2085R0204X
Hospitalist Physician 208M00000X Primary

Addresses

Primary practice location

207 Foote Ave
Jamestown, NY 14701-7077

Mailing address

PO Box 840
207 Foote Ave.
Jamestown, NY 14702-0840
Phone (716) 485-7892

Other identifiers 1

IdentifierTypeStateIssuer
03130985MedicaidNY

Other names 2

  • UPMC Chautauqua WCA Doing business as
  • The Woman's Christian Association of Jamestown NY Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040423000846 NY Part B Supplier - Clinic/Group Practice 4385630342 Receives reassigned benefits from 36 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dunkirk, NY; Jamestown, NY

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1033227111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840",
            "address_2": "207 FOOTE AVE.",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147020840",
            "telephone_number": "716-485-7892",
            "fax_number": "716-487-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 FOOTE AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147017077",
            "telephone_number": "716-487-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPMC CHAUTAUQUA AT WCA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A",
        "authorized_official_last_name": "DURNIOK",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-676-7146"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03130985",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UPMC Chautauqua WCA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Woman's Christian Association of Jamestown NY",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "The Woman's Christian Association of Jamestown NY",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jamestown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.