Jamie Leigh Walck

Primary specialty

Mastectomy FitterTaxonomy code 224900000X

Practice address

100 Rano Blvd
Vestal, NY 13850-2776

Phone

(607) 296-2021

Fax

(607) 296-2023

NPI assigned

Nov 16, 2021

Last updated

Nov 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Madeline Rose Mastectomy Boutique, LLC

  • Durable Medical Equipment & Medical Supplies
  • Vestal, NY
  • NPI 1316693765

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1637020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1336805159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RANO BLVD",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138502776",
            "telephone_number": "607-296-2021",
            "fax_number": "607-296-2023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RANO BLVD",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138502776",
            "telephone_number": "607-296-2021",
            "fax_number": "607-296-2023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALCK",
        "first_name": "JAMIE",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-16",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224900000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Mastectomy Fitter",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Andrew Vititow, O.D.
• VJNH, Inc. (Vestal Nursing Center)
• VRNC LLC (Vestal Rehabilitation & Nursing Center)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1835)
• Wal-Mart Stores East, LP. (Walmart pharmacy 10-3164)
• Walgreen Co (Rite Aid #10799)
• Kevin Alan Wall, FNP
• Kelsey Elaine Wallach, DPT
• Jessica Walter
• Mo Walts

• Mastectomy Fitter in Vestal, NY
• Providers in Vestal, NY by specialty
• Mastectomy Fitter in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.