Individual provider Active NPI

Andrew Zilka

  • Physician Assistant
  • Watertown, NY
National Provider Identifier
1104286582
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
22567 Summit Dr
Watertown, NY 13601-7210
Phone
(315) 779-6784
Fax
(315) 779-6799
NPI assigned
Feb 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

22567 Summit Dr
Watertown, NY 13601-7210

Mailing address

22567 Summit Dr BLDG 2
Watertown, NY 13601-7210
Phone (315) 779-6784

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
I20230907002798 NY Practitioner - Physician Assistant 1153785258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Samaritan Medical Practice PCGroup PAC ID 5698853133, 29 clinicians

Practice addresses (Care Compare)

22567 Summit Dr
Watertown, NY 13601-7210
Phone (315) 779-6784

629 Washington St
Watertown, NY 13601-4836
Phone (315) 755-3650

Hospital & facility affiliations

  • Samaritan Medical Center Hospital, Watertown, NY, CCN 330157

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
026151NYMDOccupational Therapist

Interoperability endpoints

  • Direct secure messaging: azilka@samaritanmedicalpractice.medentdirect.com

Organizations & group practices 1

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1104286582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22567 SUMMIT DR BLDG 2",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136017210",
            "telephone_number": "315-779-6784",
            "fax_number": "315-779-6799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22567 SUMMIT DR",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136017210",
            "telephone_number": "315-779-6784",
            "fax_number": "315-779-6799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZILKA",
        "first_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-29",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

Verify at the official NPI Registry.