NPIMap

Organization Active NPI

Western New York Dermatology, PLLC

  • Specialist
  • Williamsville, NY
National Provider Identifier
1083030498
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
WESTERN NEW YORK DERMATOLOGY, PLLC
Practice address
297 Spindrift Dr
Williamsville, NY 14221-7894
Phone
(716) 831-2600
NPI assigned
Mar 10, 2014
Last updated
Oct 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

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

Authorized official

Name
Beverly Wittmeyer
Title
Business Manager/Consultant
Phone
(716) 831-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

297 Spindrift Dr
Williamsville, NY 14221-7894

Mailing address

297 Spindrift Dr
Williamsville, NY 14221-7894

Other practice location 1

295 Spindrift Dr
Williamsville, NY 14221
Phone (716) 831-2600 ext. 118

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jasonrizzo@westernnyderm.ema.md

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150204000509 NY Part B Supplier - Clinic/Group Practice 6103141619 Receives reassigned benefits from 19 practitioners
Practice locations: Williamsville, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2177762Western New York Dermatology, PLLC297 Spindrift Drive - Ste 100, Williamsville, NY 14221Provider-performed microscopyJan 16, 2028
33D2320163Western New York Dermatology295 Spindrift Drive, Williamsville, NY 14221RegistrationJun 2, 2027

National Provider Directory

National Provider Directory

Locations

2821 Wehrle Dr
Ste 12
Williamsville, NY 14221
Phone (716) 870-6019

295 Spindrift Dr
Williamsville, NY 14221
Phone 7168312600 ext. 118

297 Spindrift Dr
Ste 100
Williamsville, NY 14221
Phone (716) 631-8863

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1083030498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 SPINDRIFT DR",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142217894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 SPINDRIFT DR",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142217894",
            "telephone_number": "716-831-2600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "295 Spindrift Dr",
            "address_purpose": "LOCATION",
            "city": "Williamsville",
            "state": "NY",
            "postal_code": "14221",
            "country_code": "US",
            "telephone_number": "716-831-2600 x118",
            "fax_number": "716-831-2601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WESTERN NEW YORK DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-10",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A",
        "authorized_official_last_name": "WITTMEYER",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "BUSINESS MANAGER/CONSULTANT",
        "authorized_official_telephone_number": "716-831-2600"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jasonrizzo@westernnyderm.ema.md",
            "affiliation": "N",
            "address_1": "295 Spindrift Dr",
            "city": "Williamsville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "14221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.