Individual provider Active NPI

Linda Claire Renganathan

  • Physician Assistant
  • Buffalo, NY
National Provider Identifier
1043512973
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
019641 Issued in NY
Practice address
Elm and Carlton St
Buffalo, NY 14263
Phone
(716) 845-2300
NPI assigned
Nov 29, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA054698 PA
Medical Physician Assistant 363AM0700X 019641 NY
Physician Assistant 363A00000X 019641 NY Primary

Addresses

Primary practice location

Elm and Carlton St
Buffalo, NY 14263

Mailing address

3624 Market St
Suite 560W
Philadelphia, PA 19104-2614
Phone (215) 662-3958

Other practice location 1

800 Spruce St
3B Ortho
Philadelphia, PA 19107-6130
Phone (215) 829-2222

Other identifiers 1

IdentifierTypeStateIssuer
019641OtherNYNY LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160824000702 NY Practitioner - Physician Assistant 0345424818 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Roswell Park Cancer InstituteGroup PAC ID 3577475110, 487 clinicians

Practice addresses (Care Compare)

Elm and Carlton St
Buffalo, NY 14263-0001
Phone (716) 845-2300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019641NYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Roswell Park Cancer Institute CurrentSince Mar 10, 2018 Accepting new patients
Roswell Park Cancer Institute CurrentSince Mar 10, 2018 Accepting new patients

Locations

Dept 8000
Buffalo, NY 14267

Elm and Carlton St
Buffalo, NY 14263

2605 Harlem Rd
Cheektowaga, NY 14225
Phone (716) 891-2315

Organizations & group practices 3

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 1

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": "1290988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1043512973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 MARKET ST",
            "address_2": "SUITE 560W",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042614",
            "telephone_number": "215-662-3958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ELM AND CARLTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14263",
            "telephone_number": "716-845-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Spruce St",
            "address_2": "3B Ortho",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191076130",
            "country_code": "US",
            "telephone_number": "215-829-2222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENGANATHAN",
        "first_name": "LINDA",
        "middle_name": "CLAIRE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-29",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA054698",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "019641",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "019641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY LICENSE",
            "identifier": "019641",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.