Individual provider Active NPI

Cheryl Pietromicca, PA

  • Physician Assistant
  • Buffalo, NY
National Provider Identifier
1083653299
Registry record updated Oct 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
009516 Issued in NY
Practice address
462 Grider St
Buffalo, NY 14215-3021
Phone
(716) 898-4803
NPI assigned
Jun 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 009516 NY Primary

Addresses

Primary practice location

462 Grider St
Buffalo, NY 14215-3021

Mailing address

140 Monarch Dr
Amherst, NY 14226-1523
Phone (716) 867-6381

Other identifiers 3

IdentifierTypeStateIssuer
00026762101OtherNYEXCELLUS UNIVERA
000527486006OtherNYHEALTH NOW
9512451OtherNYINDEPENDENT HEALTH

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
I20040315000294 NY Practitioner - Physician Assistant 0042109274 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
89 of 100Reported as group
Quality
76.13
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Medical Wny PC CurrentSince Dec 11, 2020 Accepting new patients
Ub Family Medicine, Inc Current Accepting new patients
Trinity Medical Wny PC Physician Assistant CurrentSince Dec 11, 2020 Accepting new patients

Locations

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

144 Genesee St
Fl 3
Buffalo, NY 14203
Phone (716) 601-3690

3435 Bailey Ave
Buffalo, NY 14215
Phone (716) 835-2966

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

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

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": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349913600000",
    "number": "1083653299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 MONARCH DR",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142261523",
            "telephone_number": "716-867-6381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 GRIDER ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142153021",
            "telephone_number": "716-898-4803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIETROMICCA",
        "first_name": "CHERYL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2012-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "009516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS UNIVERA",
            "identifier": "00026762101",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NOW",
            "identifier": "000527486006",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "9512451",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.