Individual provider Active NPI

Nicole Mangione, PA-C

  • Physician Assistant
  • Cheektowaga, NY
National Provider Identifier
1275971020
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
016686 Issued in NY
Practice address
2605 Harlem Rd
Cheektowaga, NY 14225-4018
Phone
(716) 891-2400
NPI assigned
Jun 13, 2013
Last updated
Dec 9, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 016686 NY Primary
Medical Physician Assistant 363AM0700X NU

Addresses

Primary practice location

2605 Harlem Rd
Cheektowaga, NY 14225-4018

Mailing address

345 Barbados Dr
Cheektowaga, NY 14227-2534
Phone (716) 907-4350

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
I20131007000322 NY Practitioner - Physician Assistant 1658505656 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Western New York Immediate Medical Care LLC CurrentSince Jul 1, 2013 Accepting new patients
Western New York Immediate Medical Care LLC CurrentSince Jul 1, 2013 Accepting new patients

Locations

2099 Niagara Falls Blvd
Amherst, NY 14228
Phone (716) 204-2273

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1275971020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 BARBADOS DR",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142272534",
            "telephone_number": "716-907-4350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 HARLEM RD",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142254018",
            "telephone_number": "716-891-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGIONE",
        "first_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-13",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016686",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheektowaga, NY

Sources for this page

Verify at the official NPI Registry.