NPIMap

Individual provider Active NPI

Laura Pankiewicz, PA-C

  • Physician Assistant
  • Williamsville, NY
National Provider Identifier
1184033557
Registry record updated Sep 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
017648-1 Issued in NY
Practice address
60 Maple Rd
Suite 1
Williamsville, NY 14221-2917
Phone
(716) 626-5250
Fax
(716) 626-5345
NPI assigned
Aug 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 017648-1 NY Primary

Addresses

Primary practice location

60 Maple Rd
Suite 1
Williamsville, NY 14221-2917

Mailing address

60 Maple Rd
Suite 1
Williamsville, NY 14221-2917
Phone (716) 626-5250

Other identifiers 1

IdentifierTypeStateIssuer
03966630MedicaidNY

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
I20141017000799 NY Practitioner - Physician Assistant 2668693557 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital of BuffaloGroup PAC ID 8729991666, 198 clinicians

Practice addresses (Care Compare)

2157 Main St
Buffalo, NY 14214-2648
Phone (716) 862-1000

565 Abbott Rd
Buffalo, NY 14220-2039
Phone (716) 826-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
017648-1NYMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mount St. Mary's Hospital of Niagara Falls CurrentSince Nov 1, 2020 Accepting new patients
Mercy Hospital of Buffalo CurrentSince Oct 28, 2019 Accepting new patients
Eastern Great Lakes Pathology PC Current Accepting new patients
Mercy Hospital of Buffalo CurrentSince Oct 28, 2019 Accepting new patients
Kenmore Mercy Hospital CurrentSince Nov 1, 2020 Accepting new patients
Sisters of Charity Hospital of Buffalo New York CurrentSince Nov 1, 2020 Accepting new patients
Sisters of Charity Hospital of Buffalo New York CurrentSince Nov 1, 2020 Accepting new patients
TLC Health Network CurrentSince Sep 17, 2014 Accepting new patients
Sisters of Charity Hospital of Buffalo, New York Current Accepting new patients
Mount St. Mary's Hospital of Niagara Falls Physician Assistant CurrentSince Nov 1, 2020 Accepting new patients
Gastrointestinal Group Past Accepting new patients
Mercy Hospital of Buffalo Past Accepting new patients

Locations

144 Genesee St
Fl 3
Buffalo, NY 14203
Phone (716) 601-3690

565 Abbott Rd
Buffalo, NY 14220
Phone (716) 826-7000

565 Abbott Rd
#2
Buffalo, NY 14220

34 Commercial St
Gowanda, NY 14070
Phone (716) 532-3377

12644 Seneca Rd
Irving, NY 14081
Phone (716) 951-7000

5300 Military Rd
Stela Niagara, NY 14092
Phone (716) 297-4800

2950 Elmwood Ave
Tonawanda, NY 14217
Phone (716) 447-6100

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 1

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": "1407628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569715200000",
    "number": "1184033557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MAPLE RD",
            "address_2": "SUITE 1",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142212917",
            "telephone_number": "716-626-5250",
            "fax_number": "716-626-5345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MAPLE RD",
            "address_2": "SUITE 1",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142212917",
            "telephone_number": "716-626-5250",
            "fax_number": "716-626-5345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANKIEWICZ",
        "first_name": "LAURA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-10",
        "last_updated": "2019-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "017648-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03966630",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.