Krista Lauren Vanderwall, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

022744 Issued in NY

Practice address

100 College Pkwy Ste 160
Williamsville, NY 14221-6800

Phone

(716) 500-2663

NPI assigned

Aug 22, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

General Physician PCGroup PAC ID 9537213079, 488 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kblask@gppc.medentdirect.com

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.

• General Physician, PC

  • General Practice Physician
  • Dunkirk, NY
  • NPI 1093959322
  Medicare reassignment Care Compare group
• County of Erie Comptrollers Office

  • Public Health or Welfare Agency
  • Buffalo, NY
  • NPI 1134210313
  Medicare reassignment NPD
• Buffalo Emergency Associates LLP

  • Emergency Medicine Physician
  • Williamsville, NY
  • NPI 1508816521
  Medicare reassignment

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1073094769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 448",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142400488",
            "telephone_number": "716-852-4772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COLLEGE PKWY STE 160",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142216800",
            "telephone_number": "716-500-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERWALL",
        "first_name": "KRISTA",
        "middle_name": "LAUREN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-22",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen M Vaccaro, PA
• Jenna Calabrese Vaeth, PT
• Gayatri Vaidyanathan, MBBS
• Barbara Ann Valachos, COTA
• Valerie Vullo M.D., LLC
• Danielle Lynn Vandette, PA
• Maurice Vansice, NP
• Kelli Varden, MS ED./CCC-SLP
• Laura M Vargovich, PT
• Andras J Vari, MD

• Physician Assistant in Williamsville, NY
• Providers in Williamsville, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.