Individual provider Active NPI

Alice Iradukunda

  • Physician Assistant
  • Buffalo, NY
National Provider Identifier
1245055854
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
155 Lawn Ave
Buffalo, NY 14207-1816
Phone
(716) 875-2904
Fax
(716) 875-6717
NPI assigned
Nov 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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 NY Primary

Addresses

Primary practice location

155 Lawn Ave
Buffalo, NY 14207-1816

Mailing address

155 Lawn Ave
Buffalo, NY 14207-1816
Phone (716) 875-2904

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
I20250521002903 NY Practitioner - Physician Assistant 4183143365 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

155 Lawn Ave
Buffalo, NY 14207-1816
Phone (716) 875-2904

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Neighborhood Health Center of Wny, Inc. CurrentSince Mar 14, 2025 Accepting new patients
Neighborhood Health Center of Wny, Inc. CurrentSince Mar 14, 2025 Accepting new patients

Locations

155 Lawn Ave
Buffalo, NY 14207
Phone (716) 875-2904

300 Niagara St
Buffalo, NY 14201
Phone (716) 242-8600

Interoperability endpoints

  • Direct secure messaging: alice.iradukunda.1@26491.direct.athenahealth.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.

NPI Registry JSON

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

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1245055854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 LAWN AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142071816",
            "telephone_number": "716-875-2904",
            "fax_number": "716-875-6717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 LAWN AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142071816",
            "telephone_number": "716-875-2904",
            "fax_number": "716-875-6717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRADUKUNDA",
        "first_name": "ALICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-19",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.