Wallace Carlisle Watson Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001255 Issued in NY

Practice address

21 E Main St
Cuba, NY 14727-1205

Phone

(585) 968-4357

Fax

(585) 968-4356

NPI assigned

Jun 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22039/brand/2/csg/1/fhir/r4

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.

• Olean Medical Group

  • Multi-Specialty Clinic/Center
  • Olean, NY
  • NPI 1598158164
  NPD (past)
• Olean Open MRI PC

  • Diagnostic Radiology Physician
  • Olean, NY
  • NPI 1891736302
  NPD (past)
• Salamance Family Health Center

  • Primary Care Clinic/Center
  • Salamanca, NY
  • NPI 1609009372
  NPD (past)
• Sleep Insights Medical Services, LLC

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Rochester, NY
  • NPI 1538345814
  NPD (past)
• Zia Sheikh MD Professional Corporation

  • Internal Medicine Physician
  • Olean, NY
  • NPI 1548462880
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369699200000",
    "number": "1073554150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 W STATE ST",
            "address_2": "SUITE 121",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147601951",
            "telephone_number": "716-372-2708",
            "fax_number": "716-372-8682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 E MAIN ST",
            "city": "CUBA",
            "state": "NY",
            "postal_code": "147271205",
            "telephone_number": "585-968-4357",
            "fax_number": "585-968-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "WALLACE",
        "middle_name": "CARLISLE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2013-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "0012551",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "001255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA",
            "identifier": "0490352",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00010257702",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "407113852",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCWNY",
            "identifier": "000508499002",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "2598491",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01531593",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Griffin Velez, PHARM.D.
• Peter J Vishton, O.D.
• John Waide
• Walgreen Co
• Meghann Kathleen Warren
• Jessika Marie Weitzel
• Jennifer Louise Williamson, MS-CCC-SLP
• Tina Wilson, LMHC
• Sharon Lee Wittmeyer Crowley, COTA
• Marlene Wust-Smith, MD

• All providers in Cuba, NY
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.