Canalside Primary Care PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

229399 Issued in NY

Legal business name

CANALSIDE PRIMARY CARE PC

Practice address

43 Niagara St
North Tonawanda, NY 14120-6115

Phone

(716) 690-2001

Fax

(716) 690-2239

NPI assigned

Mar 1, 2007

Organization subpart

No

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

Authorized official

Name

Lynne Susan Ross, MDNPI 1154388049

Title

Owner

Phone

(716) 690-2001

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lynne Ross MD PC Former legal business name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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

• Lynne S Ross, MD

  • Family Medicine Physician
  • North Tonawanda, NY
  • NPI 1154388049
  Medicare reassignment Care Compare group NPD Authorized official
• Stephany Ruszala, PA-C

  • Physician Assistant
  • North Tonawanda, NY
  • NPI 1679253223
  Medicare reassignment Care Compare group
• Alyssa Weaver, PA-C

  • Physician Assistant
  • North Tonawanda, NY
  • NPI 1841911039
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577318400000",
    "number": "1174651046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 NIAGARA FALLS BLVD STE 208",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141202019",
            "telephone_number": "716-692-3302",
            "fax_number": "716-692-4342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 NIAGARA ST",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141206115",
            "telephone_number": "716-690-2001",
            "fax_number": "716-690-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANALSIDE PRIMARY CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "LYNNE",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-690-2001",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "229399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02494544",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lynne Ross MD PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Suzanne Carroll Burke
• Anthony John Buscaglia, D.C.
• Kelly Byrne
• Paul A Cain, RPH
• Tara Nichole Caldwell, MS E.D.
• Kimberly Elizabeth Capriotti, LMSW
• Kathryn A Cardona, PT
• David Eugene Carlson Jr., M.D.
• Amy Caron, RNFA FIRST ASSIST
• Kimberlee M Carpenter, P.T.

• Family Medicine Physician in North Tonawanda, NY
• Providers in North Tonawanda, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.