NPIMap

Organization Active NPI

Pediatrics & Adolescent Medicine Group

  • Pediatric Adolescent Medicine Physician
  • Rochester, NY
National Provider Identifier
1104861772
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
PEDIATRICS & ADOLESCENT MEDICINE GROUP
Practice address
601 Elmwood Ave
Box 635
Rochester, NY 14642-0001
Phone
(585) 275-7787
Fax
(585) 275-2352
NPI assigned
Jun 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Jill M Hetterich
Title
Senior Director of Finance Urmfg
Phone
(585) 756-4008

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X
Clinical Cardiac Electrophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0001X
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

601 Elmwood Ave
Box 635
Rochester, NY 14642-0001

Mailing address

601 Elmwood Ave
Box 635
Rochester, NY 14642-0001
Phone (585) 784-9749

Other identifiers 1

IdentifierTypeStateIssuer
00485887MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050510000924 NY Part B Supplier - Clinic/Group Practice 9133169022 Receives reassigned benefits from 19 practitioners
Practice locations: Rochester, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1104861772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "address_2": "BOX 635",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-784-9749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "address_2": "BOX 635",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-275-7787",
            "fax_number": "585-275-2352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS & ADOLESCENT MEDICINE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "HETTERICH",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SENIOR DIRECTOR OF FINANCE URMFG",
        "authorized_official_telephone_number": "585-756-4008"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00485887",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.