NPIMap

Organization Active NPI

Western New York Radiology Associates LLC

  • Diagnostic Radiology Physician
  • Buffalo, NY
National Provider Identifier
1285682500
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
WESTERN NEW YORK RADIOLOGY ASSOCIATES LLC
Practice address
100 High St
Buffalo, NY 14203-1126
Phone
(716) 859-2954
Fax
(716) 859-2962
NPI assigned
May 5, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Kenneth D Pearsen, MDNPI 1154387918
Title
President/Ceo
Phone
(716) 859-2954

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 67

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 67

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315000217 NY Part B Supplier - Clinic/Group Practice 3072402296 Receives reassigned benefits from 49 practitioners
Practice locations: Buffalo, NY; N Tonawanda, NY; Williamsville, NY

National Provider Directory

National Provider Directory

Locations

111 N Maplemere Rd
Ste 120
Williamsville, NY 14221
Phone (716) 836-4646

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

NPPES NPI Registry

Primary practice location

100 High St
Buffalo, NY 14203-1126

Mailing address

111 N Maplemere Rd Ste 120
Williamsville, NY 14221-3178
Phone (716) 836-4646

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
02383255MedicaidNY
DA0528OtherRR MEDICARE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 21, 2023.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1285682500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N MAPLEMERE RD STE 120",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213178",
            "telephone_number": "716-836-4646",
            "fax_number": "716-836-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HIGH ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031126",
            "telephone_number": "716-859-2954",
            "fax_number": "716-859-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN NEW YORK RADIOLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "PEARSEN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "716-859-2954",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02383255",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DA0528",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.