Jack William Dormer, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

030380 Issued in NY

Practice address

111 North Maplemere Road
Suite 100
Williamsville, NY 14221

Phone

(716) 204-3200

Fax

(716) 204-4337

NPI assigned

Aug 9, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University Orthopaedic Services Inc.Group PAC ID 7810983004, 115 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.69 of 100Reported as group

Quality

77.6

Promoting interoperability

100

Improvement activities

40

Cost

81.28

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jdormer@ubortho.medentdirect.com

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.

• University Orthopaedic Services, Inc

  • Orthopaedic Surgery Physician
  • Cheektowaga, NY
  • NPI 1578599866
  Medicare reassignment Care Compare group NPD
• University Orthopaedic Services Inc.

  • Orthopaedic Surgery Physician
  • Amherst, NY
  • NPI 1528209962
  NPD

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1285317024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 GENESEE ST STE 400",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142251994",
            "telephone_number": "716-204-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NORTH MAPLEMERE ROAD",
            "address_2": "SUITE 100",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "14221",
            "telephone_number": "716-204-3200",
            "fax_number": "716-204-4337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORMER",
        "first_name": "JACK",
        "middle_name": "WILLIAM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-09",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "030380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Christopher Dominguez, DPT
• Jessen Rebekah Donlon
• Shannon Charmaine Donovan, FNP
• Suzanne Donovan, LCSW
• David John Dormandy Jr., D.O
• Penny Dortch, LPN
• David R Dougherty, DO
• Jacquelyn M Dougherty, OD
• Harold O Douglass Jr., M.D.
• Therese Dowd, LPN

• Physician Assistant in Williamsville, NY
• Providers in Williamsville, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; 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.