Bobbie Rae Faivus Vangorder, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

014226 Issued in NY

Practice address

110 W Utica St
Oswego, NY 13126-3047

Phone

(315) 349-5537

NPI assigned

Oct 5, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Physician Care PCGroup PAC ID 9032367453, 74 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Liverpool, NY, CCN 337255
• Oswego Health Home Care, LLC Home health agency, Fulton, NY, CCN 337284
• Oswego Hospital Hospital, Oswego, NY, CCN 330218

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: bvangorder@oswegohealth.medentdirect.com

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.

• Physician Care PC

  • Internal Medicine Physician
  • Oswego, NY
  • NPI 1073868113
  Medicare reassignment Care Compare group
• Dr. Padma Ram Medical Services, LLC

  • Rural Health Clinic/Center
  • Oswego, NY
  • NPI 1336835024
  NPD (past)

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

• Oswego Health Home Care LLC..

  • Home Health Agency
  • Fulton, NY
  • NPI 1285639625
  Care Compare affiliation
• Oswego Hospital

  • General Acute Care Hospital
  • Oswego, NY
  • NPI 1871678458
  Care Compare affiliation
• QC-Medi New York, Inc.

  • Home Health Agency
  • Syracuse, NY
  • NPI 1912939489
  Care Compare affiliation

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1154630366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W 6TH ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131262507",
            "telephone_number": "315-349-5511",
            "fax_number": "315-349-5921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W UTICA ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131263047",
            "telephone_number": "315-349-5537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 College Plaza",
            "address_purpose": "LOCATION",
            "city": "Oswego",
            "state": "NY",
            "postal_code": "131261731",
            "country_code": "US",
            "telephone_number": "315-342-0030 x102",
            "fax_number": "315-342-0258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANGORDER",
        "first_name": "BOBBIE RAE",
        "middle_name": "FAIVUS",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-05",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "014226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Marie Vaccaro I, B.S, M.S
• Amanda Anne Van Auken
• Taylor Van Camp
• Scott C. Van Gorder, D.O.
• Jon Robert Vanderweele, DO
• Alicia Lynne Vann, PT, DPT
• Corliss Adam Varnum, M.D.
• Ruth Noemi Vasquez, NP
• Jennifer Lynn Vayner, PTA
• Nichole Leone Veaudry, PTA

• Medical Physician Assistant in Oswego, NY
• Providers in Oswego, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.