NPIMap

Individual provider Active NPI

Donald E Gullickson II, D.O.

  • Internal Medicine Physician
  • Buffalo, NY
National Provider Identifier
1124080056
Registry record updated Jul 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
186403 Issued in NY
Practice address
1783 Colvin Blvd
Buffalo, NY 14223-1107
Phone
(716) 874-2150
Fax
(716) 874-6765
NPI assigned
Apr 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 186403 NY Primary

Addresses

Primary practice location

1783 Colvin Blvd
Buffalo, NY 14223-1107

Mailing address

1783 Colvin Blvd
Buffalo, NY 14223-1107
Phone (716) 874-2150

Other identifiers 1

IdentifierTypeStateIssuer
1295587MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110801000816 NY Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 7315950912 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
West Virginia School of Osteopathic Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northtowns Medical Group, P.C.Group PAC ID 9234142837, 5 clinicians

Practice addresses (Care Compare)

1783 Colvin Blvd
Buffalo, NY 14223-1107
Phone (716) 874-2150

Hospital & facility affiliations

  • McAuley Seton Home Care Corp Chha Home health agency, Buffalo, NY, CCN 337251
  • Vna of Western Ny Chha Home health agency, Cheektowaga, NY, CCN 337006
  • Niagara Hospice Inc Hospice, Lockport, NY, CCN 331530
  • Kaleida Health Hospital, Buffalo, NY, CCN 330005
  • Kenmore Mercy Hospital Hospital, Kenmore, NY, CCN 330102
  • Sisters of Charity Hospital Hospital, Buffalo, NY, CCN 330078

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Northtowns Medical Group, P.C. Internal Medicine CurrentSince Jan 1, 1999 Accepting new patients
Cardiology Reading Panel LLC Past Accepting new patients

Locations

1783 Colvin Blvd
Buffalo, NY 14223
Phone (716) 874-2150

Interoperability endpoints

  • Direct secure messaging: dgullickson@nmg.medentdirect.com

Organizations & group practices 2

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 12

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": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311206400000",
    "number": "1124080056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1783 COLVIN BLVD",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142231107",
            "telephone_number": "716-874-2150",
            "fax_number": "716-874-6765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1783 COLVIN BLVD",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142231107",
            "telephone_number": "716-874-2150",
            "fax_number": "716-874-6765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLICKSON",
        "first_name": "DONALD",
        "middle_name": "E",
        "name_suffix": "II",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2011-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "186403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295587",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.