NPIMap

Organization Active NPI

Churchville-Chili Family Medicine, LLC

  • Family Medicine Physician
  • North Chili, NY
National Provider Identifier
1326231291
Registry record updated Nov 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
174814 Issued in NY
Legal business name
CHURCHVILLE-CHILI FAMILY MEDICINE, LLC
Practice address
4201 Buffalo Rd
Box 505
North Chili, NY 14514-1256
Phone
(585) 594-5995
Fax
(585) 594-5425
NPI assigned
Aug 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2014

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

Authorized official

Name
Dr. Henry Mikolaj Paszko, MDNPI 1043260730
Title
Medical Director
Phone
(585) 594-5994

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 174814 NY Primary
Clinic/Center 261Q00000X 174814 NY

Addresses

Primary practice location

4201 Buffalo Rd
Box 505
North Chili, NY 14514-1256

Mailing address

PO Box 505
N. Chili, NY 14514
Phone (585) 594-5995

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141114001670 NY Part B Supplier - Clinic/Group Practice 5294957874 Receives reassigned benefits from 17 practitioners
Practice locations: North Chili, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D1028474Churchville Chili Family Medicine4201 Buffalo Road PO Box 505, North Chili, NY 14514Provider-performed microscopyJun 4, 2028

National Provider Directory

National Provider Directory

Locations

4201 Buffalo Rd
#505
North Chili, NY 14514
Phone (585) 594-5995

4201 Buffalo Rd
Ste 1
North Chili, NY 14514
Phone (585) 594-5995

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1326231291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505",
            "city": "N. CHILI",
            "state": "NY",
            "postal_code": "14514",
            "telephone_number": "585-594-5995",
            "fax_number": "585-594-5425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 BUFFALO RD",
            "address_2": "BOX 505",
            "city": "NORTH CHILI",
            "state": "NY",
            "postal_code": "145141256",
            "telephone_number": "585-594-5995",
            "fax_number": "585-594-5425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCHVILLE-CHILI FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-23",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "PASZKO",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "MIKOLAJ",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "585-594-5994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "174814",
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": "174814",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Chili, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.