Organization Active NPI

Main Gastroenterology. P.C.

  • Gastroenterology Physician
  • Williamsville, NY
National Provider Identifier
1275715005
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
159226-1 Issued in NY
Legal business name
MAIN GASTROENTEROLOGY. P.C.
Practice address
8201 Main St. Ste 4
Williamsville, NY 14221
Phone
(716) 632-3577
Fax
(716) 631-8275
NPI assigned
Dec 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Authorized official

Name
Dr. Anonino Manonne, M.D.
Title
Physician
Phone
(716) 632-3577

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X 159226-1 NY Primary

Addresses

Primary practice location

8201 Main St. Ste 4
Williamsville, NY 14221

Mailing address

6637 Main St
Williamsville, NY 14221-5974
Phone (716) 632-3576

Other identifiers 2

IdentifierTypeStateIssuer
00801969MedicaidNY
00902098MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080116000394 NY Part B Supplier - Clinic/Group Practice 5597846527 Receives reassigned benefits from 1 practitioner
Practice locations: Williamsville, NY

National Provider Directory

National Provider Directory

Locations

8207 Main St
Ste 8
Williamsville, NY 14221
Phone (716) 632-3577

Practitioners & affiliated clinicians

Practitioners 1

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": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587945600000",
    "number": "1275715005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6637 MAIN ST",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142215974",
            "telephone_number": "716-632-3576",
            "fax_number": "716-631-8275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 MAIN ST. STE 4",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "14221",
            "telephone_number": "716-632-3577",
            "fax_number": "716-631-8275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN GASTROENTEROLOGY. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A",
        "authorized_official_last_name": "MANONNE",
        "authorized_official_first_name": "ANONINO",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "716-632-3577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "159226-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00801969",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00902098",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; 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.