Individual provider Active NPI

Angelina M Miseno-Callaghan, RPA-C

  • Physician Assistant
  • Halfmoon, NY
National Provider Identifier
1073505285
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601007026 Issued in MI
Practice address
1694 Route 9
Halfmoon, NY 12065-8816
Phone
(518) 930-7486
Fax
(518) 930-7487
NPI assigned
Aug 16, 2005
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
Family Medicine Physician 207Q00000X 009607 NY
Medical Physician Assistant 363AM0700X 009607 NY
Physician Assistant 363A00000X 5601007026 MI Primary

Addresses

Primary practice location

1694 Route 9
Halfmoon, NY 12065-8816

Mailing address

PO Box 500
Ellicottville, NY 14731-0500
Phone (716) 699-9032

Other practice location 1

511 Medical Plaza Dr
suite 101
Leesburg, FL 34748-7326
Phone (352) 728-6808

Other names 1

  • Ms. Angelina M Camino Former name

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
I20040824000272 NY Practitioner - Physician Assistant 7214901420 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellnow Urgent Care, P.C.Group PAC ID 8325320864, 395 clinicians

Practice addresses (Care Compare)

1694 Route 9
Halfmoon, NY 12065-8816
Phone (518) 930-7486

202 Broad St
Glens Falls, NY 12801-4146
Phone (518) 480-6240

204 S Broadway
Saratoga Springs, NY 12866-4570
Phone (518) 226-3288

233 Saratoga Rd
Glenville, NY 12302-4508
Phone (518) 930-7497

445 Balltown Rd
Suite 1
Schenectady, NY 12304-2269
Phone (518) 387-3566

7375 Oswego Rd
Suite 1
Liverpool, NY 13090-3717
Phone (315) 291-0064

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
009607NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Healthcare CurrentSince Sep 1, 2014 Accepting new patients
St Marys Healthcare CurrentSince Sep 1, 2014 Accepting new patients
Ze'Ev W. Weitz, MD Past Accepting new patients

Locations

380 Guy Park Ave
Amsterdam, NY 12010
Phone (518) 841-7415

427 Guy Park Ave
Amsterdam, NY 12010
Phone (518) 442-1404

4950 State Highway 30
Amsterdam, NY 12010
Phone (518) 770-7557

425 Guy Park Ave
Amsterdam, NY 12010
Phone (518) 842-3330

7 Timmerman Ave
St Johnsville, NY 13452
Phone (518) 568-5037

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1073505285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "ELLICOTTVILLE",
            "state": "NY",
            "postal_code": "147310500",
            "telephone_number": "716-699-9032",
            "fax_number": "716-369-9590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1694 ROUTE 9",
            "city": "HALFMOON",
            "state": "NY",
            "postal_code": "120658816",
            "telephone_number": "518-930-7486",
            "fax_number": "518-930-7487"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "511 Medical Plaza Dr",
            "address_2": "suite 101",
            "address_purpose": "LOCATION",
            "city": "Leesburg",
            "state": "FL",
            "postal_code": "347487326",
            "country_code": "US",
            "telephone_number": "352-728-6808",
            "fax_number": "352-728-3637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MISENO-CALLAGHAN",
        "first_name": "ANGELINA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-16",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "009607",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "009607",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELINA",
            "last_name": "CAMINO",
            "middle_name": "M",
            "prefix": "MS.",
            "credential": "RPA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Halfmoon, NY

Sources for this page

Verify at the official NPI Registry.