Brummitte Dale Wilson, M.D.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

134469 Issued in NY

Practice address

3900 N Buffalo St
Orchard Park, NY 14127-1842

Phone

(716) 656-4494

Fax

(716) 648-1552

NPI assigned

Jul 6, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

State University of New York at Buffalo School of Medicine, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Buffalo Medical Group, P.C.Group PAC ID 7012820301, 233 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: production@direct.buffalomedicalgroup.com
• Direct secure messaging: bwilson14465@direct.buffalomedicalgroup.com

Practitioners 2

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

• Cornelie M. Jones, MD

  • Dermatology Physician
  • Orchard Park, NY
  • NPI 1699772913
  Medicare reassignment
• Peter Santa Lucia, M.D.

  • Procedural Dermatology Physician
  • Orchard Park, NY
  • NPI 1578561247
  Medicare reassignment

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.

• Buffalo Medical Group, P.C.

  • Family Medicine Physician
  • Williamsville, NY
  • NPI 1881659506
  Medicare reassignment Care Compare group NPD
• Buffalo Medical Group, P.C.

  • Durable Medical Equipment & Medical Supplies
  • Lockport, NY
  • NPI 1982566782
  NPD

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1245237288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 ESSJAY RD STE 170",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142218235",
            "telephone_number": "716-630-1219",
            "fax_number": "716-817-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 N BUFFALO ST",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271842",
            "telephone_number": "716-656-4494",
            "fax_number": "716-648-1552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 Essjay Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Williamsville",
            "state": "NY",
            "postal_code": "142215782",
            "country_code": "US",
            "telephone_number": "716-630-1000",
            "fax_number": "716-648-1552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 Essjay Rd",
            "address_purpose": "LOCATION",
            "city": "Williamsville",
            "state": "NY",
            "postal_code": "142218243",
            "country_code": "US",
            "telephone_number": "716-630-1000",
            "fax_number": "716-684-1552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "85 High St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142031194",
            "country_code": "US",
            "telephone_number": "716-630-1000",
            "fax_number": "716-648-1552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17 Long Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Hamburg",
            "state": "NY",
            "postal_code": "140756200",
            "country_code": "US",
            "telephone_number": "716-648-2770",
            "fax_number": "716-646-4642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRUMMITTE",
        "middle_name": "DALE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "134469",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NY",
            "license": "1344691",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "production@direct.buffalomedicalgroup.com",
            "affiliation": "Y",
            "affiliationName": "Buffalo Medical Group, P.C.",
            "address_1": "3900 N Buffalo St",
            "city": "Orchard Park",
            "state": "NY",
            "country_code": "US",
            "postal_code": "141271842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Willcare
• Alexandra Williams
• Callie Gayle Williams, DDS
• Drew Michael Williams, PHARM D
• Mary Tederous Williams, PH.D
• Laura Elaine Winkelman, CPHT
• Madison Winkler, LPN
• Paul Joseph Wirth
• Melissa M Wisniewski, NP
• Amy Lynn Wnek, M.D.

• MOHS-Micrographic Surgery Physician in Orchard Park, NY
• Providers in Orchard Park, NY by specialty
• MOHS-Micrographic Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.