Individual provider Active NPI

Mary Jo Kish, NP

  • Adult Health Nurse Practitioner
  • Cheektowaga, NY
National Provider Identifier
1184074288
Registry record updated Jun 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
307734 Issued in NY
Practice address
4225 Genesee St
Cheektowaga, NY 14225-1994
Phone
(716) 906-5908
NPI assigned
Jun 20, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 307734 NY Primary

Addresses

Primary practice location

4225 Genesee St
Cheektowaga, NY 14225-1994

Mailing address

462 Grider St
Buffalo, NY 14215-3021
Phone (716) 810-7999

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
I20161213000295 NY Practitioner - Nurse Practitioner 0941580765 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Orthopaedic Services Inc.Group PAC ID 7810983004, 115 clinicians

Practice addresses (Care Compare)

462 Grider St
Buffalo, NY 14215-3021
Phone (716) 898-3810

Merit-based Incentive Payment System (MIPS)

Final score
88.69 of 100Reported as group
Quality
77.6
Promoting interoperability
100
Improvement activities
40
Cost
81.28

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Erie County Medical Center Corporation CurrentSince Oct 12, 2016 Accepting new patients
Erie County Medical Center Corporation CurrentSince Oct 12, 2016 Accepting new patients
University Orthopaedic Services, Inc CurrentSince Oct 1, 2016 Accepting new patients
University Orthopaedic Services Inc. CurrentSince Oct 1, 2016 Accepting new patients
Erie County Medical Center Corporation Past Accepting new patients

Locations

462 Grider St
Ste 151
Buffalo, NY 14215

160 Farber Hall
Buffalo, NY 14214
Phone (716) 829-2070

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

4225 Genesee St
Cheektowaga, NY 14225
Phone (716) 829-6123

4180 Abbott Rd
Orchard Park, NY 14127
Phone (716) 648-4321

5959 Big Tree Rd
Ste 108
Orchard Park, NY 14127
Phone (716) 810-7997

111 N Maplemere Rd
Ste 100
Williamsville, NY 14221
Phone (716) 810-7997

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1184074288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "462 GRIDER ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142153021",
            "telephone_number": "716-810-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 GENESEE ST",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142251994",
            "telephone_number": "716-906-5908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISH",
        "first_name": "MARY JO",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "307734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheektowaga, NY

Sources for this page

Verify at the official NPI Registry.