Individual provider Active NPI

Victoria Elizabeth Grudzinski, PA-C

  • Medical Physician Assistant
  • Williamsville, NY
National Provider Identifier
1124330048
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
014046 Issued in NY
Practice address
61 Maple Rd
Williamsville, NY 14221-2918
Phone
(716) 565-1234
Fax
(716) 565-1246
NPI assigned
Jul 8, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 014046 NY Primary

Addresses

Primary practice location

61 Maple Rd
Williamsville, NY 14221-2918

Mailing address

61 Maple Rd
Williamsville, NY 14221-2918
Phone (716) 565-1234

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
I20101209000199 NY Practitioner - Physician Assistant 2860689304 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Care Physician, P.C.Group PAC ID 0042249328, 12 clinicians

Practice addresses (Care Compare)

61 Maple Rd
Williamsville, NY 14221-2918
Phone (716) 565-1234

Hospital & facility affiliations

  • Kaleida Health Hospital, Buffalo, NY, CCN 330005
  • Sisters of Charity Hospital Hospital, Buffalo, NY, CCN 330078
  • Kenmore Mercy Hospital Hospital, Kenmore, NY, CCN 330102

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northtowns Imaging PC PastSince Jan 29, 2023 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: vgrudzinski@familycarephysicians.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 9

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": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1124330048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 MAPLE RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142212918",
            "telephone_number": "716-565-1234",
            "fax_number": "716-565-1246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 MAPLE RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142212918",
            "telephone_number": "716-565-1234",
            "fax_number": "716-565-1246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUDZINSKI",
        "first_name": "VICTORIA",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-08",
        "last_updated": "2023-01-24",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "014046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.