NPIMap

Organization Active NPI

Baker Victory Healthcare Center

  • Multi-Specialty Clinic/Center
  • Lackawanna, NY
National Provider Identifier
1245095413
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BAKER VICTORY HEALTHCARE CENTER
Practice address
790 Ridge Road 2ND Floor
Lackawanna, NY 14218
Phone
(716) 828-7586
NPI assigned
Feb 16, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Authorized official

Name
Sheila Rena Hunt
Title
Chief Program Officer
Phone
(716) 828-9699

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

790 Ridge Road 2ND Floor
Lackawanna, NY 14218

Mailing address

790 Ridge Road 2ND Floor
Lackawanna, NY 14218
Phone (716) 828-7586

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250516002928 NY Part B Supplier - Clinic/Group Practice 3173041746 Receives reassigned benefits from 6 practitioners
Practice locations: Lackawanna, NY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

790 Ridge Rd
Fl 2
Lackawanna, NY 14218
Phone (716) 828-7586

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1708041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1245095413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 RIDGE ROAD 2ND FLOOR",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "14218",
            "telephone_number": "716-828-7586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 RIDGE ROAD 2ND FLOOR",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "14218",
            "telephone_number": "716-828-7586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAKER VICTORY HEALTHCARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-16",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A",
        "authorized_official_last_name": "HUNT",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "RENA",
        "authorized_official_title_or_position": "CHIEF PROGRAM OFFICER",
        "authorized_official_telephone_number": "716-828-9699"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lackawanna, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.