Individual provider Active NPI

Mark Edgar Kerner, PA

  • Surgical Physician Assistant
  • Williamsville, NY
National Provider Identifier
1306297874
Registry record updated Sep 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
019740 Issued in NY
Practice address
36 N Union Rd
Williamsville, NY 14221-5383
Phone
(716) 636-1470
Fax
(888) 886-2563
NPI assigned
Jun 27, 2016
Last updated
Sep 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 019740 NY Primary

Addresses

Primary practice location

36 N Union Rd
Williamsville, NY 14221-5383

Mailing address

3925 Sheridan Dr
Ste 100
Amherst, NY 14226-1738
Phone (716) 250-6492

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
I20160816000296 NY Practitioner - Physician Assistant 9335433275 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kenmore Mercy HospitalGroup PAC ID 7517870462, 54 clinicians

Practice addresses (Care Compare)

2950 Elmwood Ave
Kenmore, NY 14217-1304
Phone (716) 447-6100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.79 of 100Reported as group
Quality
89.94
Promoting interoperability
88
Improvement activities
40
Cost
82.5

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019740NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Excelsior Orthopaedics, LLP CurrentSince Oct 1, 2019 Accepting new patients
Kenmore Mercy Hospital CurrentSince Oct 24, 2021 Accepting new patients
Kenmore Mercy Hospital CurrentSince Oct 24, 2021 Accepting new patients
Excelsior Orthopaedics LLP CurrentSince Oct 1, 2019 Accepting new patients

Locations

144 Genesee St
Fl 3
Buffalo, NY 14203
Phone (716) 601-3690

3925 Sheridan Dr
Buffalo, NY 14226
Phone (716) 250-6500

3925 Sheridan Dr
Ste 100
Buffalo, NY 14226
Phone (716) 250-6492

8750 Transit Rd
Ste 105
East Amherst, NY 14051
Phone (716) 636-1470

2950 Elmwood Ave
Tonawanda, NY 14217
Phone (716) 447-6100

Interoperability endpoints

  • Direct secure messaging: mkerner@excelsiorortho.medentdirect.com

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568332800000",
    "number": "1306297874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 SHERIDAN DR",
            "address_2": "STE 100",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142261738",
            "telephone_number": "716-250-6492",
            "fax_number": "716-250-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 N UNION RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142215383",
            "telephone_number": "716-636-1470",
            "fax_number": "888-886-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERNER",
        "first_name": "MARK",
        "middle_name": "EDGAR",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-27",
        "last_updated": "2019-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "019740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.