Individual provider Active NPI

Kurtis Kiadum Suteh Kpajoh, DMSC, PA

  • Physician Assistant
  • Amherst, NY
National Provider Identifier
1255595138
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
013091 Issued in NY
Practice address
3921 Harlem Rd
Amherst, NY 14226-4703
Phone
(716) 541-0550
Fax
(315) 741-0779
NPI assigned
Jul 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 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 013091 NY Primary

Addresses

Primary practice location

3921 Harlem Rd
Amherst, NY 14226-4703

Mailing address

3921 Harlem Rd
Amherst, NY 14226-4703
Phone (716) 541-0550

Other identifiers 2

IdentifierTypeStateIssuer
J400089155OtherNYMEDICARE PTAN
03047683MedicaidNY

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
I20090126000016 NY Practitioner - Physician Assistant 9335203041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellnow Urgent Care, P.C.Group PAC ID 8325320864, 395 clinicians

Practice addresses (Care Compare)

1238 E Ridge Rd
Rochester, NY 14621-2012
Phone (585) 537-3792

1597 Elmwood Ave
Buffalo, NY 14207-3017
Phone (716) 262-3161

200 E 1St St
Oswego, NY 13126-2662
Phone (315) 207-7391

230 N Genesee St
Utica, NY 13502-2529
Phone (315) 275-3214

2980 Sheridan Dr
Tonawanda, NY 14150-9417
Phone (716) 262-3377

3190 Niagara Falls BVLD
Amherst, NY 14228-1639
Phone (716) 799-8190

3450 Union Rd
Cheektowaga, NY 14225-5120
Phone (716) 395-2043

3648 Dewey Ave
Rochester, NY 14616-3024
Phone (585) 786-3503

3980 Sheridan Dr
Amherst, NY 14226-1727
Phone (716) 929-2800

446 Fairview Ave
Suite 200
Hudson, NY 12534-1048
Phone (518) 267-3496

5965 Transit Rd
East Amherst, NY 14051-1874
Phone (716) 362-1093

6555 4TH Section Rd
Brockport, NY 14420-2441
Phone (585) 431-5364

7375 Oswego Rd
Suite 1
Liverpool, NY 13090-3717
Phone (315) 291-0064

National Provider Directory

National Provider Directory
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
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellnow Urgent Care, PC PastSince Dec 27, 2020 Accepting new patients
Wny Medical PC Physician Assistant Past Accepting new patients
FDR Medical Services P.C. Past Accepting new patients

Organizations & group practices 4

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": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1255595138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3921 HARLEM RD",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142264703",
            "telephone_number": "716-541-0550",
            "fax_number": "315-741-0779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3921 HARLEM RD",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142264703",
            "telephone_number": "716-541-0550",
            "fax_number": "315-741-0779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTEH KPAJOH",
        "first_name": "KURTIS KIADUM",
        "name_prefix": "Dr.",
        "credential": "DMSC, PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-10",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "J400089155",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03047683",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amherst, NY

Sources for this page

Verify at the official NPI Registry.