Individual provider Active NPI

Michael D Lacivita, DPM

  • Foot Surgery Podiatrist
  • Williamsville, NY
National Provider Identifier
1285651018
Registry record updated Jul 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
002240 Issued in NY
Practice address
6325 Main St
Suite 200
Williamsville, NY 14221-5822
Phone
(716) 630-1295
Fax
(716) 250-5999
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X N0060261 NY
Foot Surgery Podiatrist 213ES0131X 002240 NY Primary

Addresses

Primary practice location

6325 Main St
Suite 200
Williamsville, NY 14221-5822

Mailing address

425 Essjay Rd Ste 170
Williamsville, NY 14221-8235
Phone (716) 630-1219

Other identifiers 1

IdentifierTypeStateIssuer
02676171MedicaidNY

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050725000950 NY Practitioner - Podiatry 9234166976 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 2002
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)

3900 N Buffalo St
Orchard Park, NY 14127-1842
Phone (716) 630-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue95
Removal of skin lesions11
Removal of nail tissue677
Removal or shaving of skin growth317
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002240NYMDAcupuncturist
N0060261NYMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Southtowns Surgery Center LLC CurrentSince Nov 14, 2023 Accepting new patients
Kaleida Health CurrentSince Jan 24, 2018 Accepting new patients
Kaleida Health CurrentSince Jan 24, 2018 Accepting new patients
Buffalo Medical Group, P.C. CurrentSince Mar 1, 2015 Accepting new patients
Buffalo Medical Group, P.C. CurrentSince Mar 1, 2015 Accepting new patients
Kaleida Health Current Accepting new patients
Genesee Valley Group Health Association Past Accepting new patients

Locations

726 Exchange St
Ste 200
Buffalo, NY 14210

85 High St
Buffalo, NY 14203
Phone (716) 857-8623

2121 Main St
Ste 214
Buffalo, NY 14214
Phone (716) 400-8602

900 Hertel Ave
Buffalo, NY 14216
Phone (716) 871-1571

2121 Main St
Ste 106
Buffalo, NY 14214
Phone (716) 833-8993

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

445 Tremont St
North Tonawanda, NY 14120
Phone (716) 690-2291

3900 N Buffalo St
Orchard Park, NY 14127
Phone (716) 630-1112

5959 Big Tree Rd
Ste 100
Orchard Park, NY 14127

6325 Main St
Ste 200
Williamsville, NY 14221
Phone (716) 630-1295

425 Essjay Rd
Williamsville, NY 14221
Phone (716) 630-1219

6255 Sheridan Dr
Ste 304
Williamsville, NY 14221
Phone (716) 857-8666

425 Essjay Rd
Ste 170
Williamsville, NY 14221
Phone (716) 630-1219

Interoperability endpoints

  • Direct secure messaging: mlacivita5131@direct.buffalomedicalgroup.com

Organizations & group practices 7

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564012800000",
    "number": "1285651018",
    "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": "6325 MAIN ST",
            "address_2": "SUITE 200",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142215822",
            "telephone_number": "716-630-1295",
            "fax_number": "716-250-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACIVITA",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2019-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N0060261",
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "002240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02676171",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.