Individual provider Active NPI

Mary Gaynor, FNP

  • Registered Nurse
  • Buffalo, NY
National Provider Identifier
1356782742
Registry record updated Apr 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
630917 Issued in NY
Practice address
100 High St
Buffalo, NY 14203-1126
Phone
(716) 859-2401
NPI assigned
Jul 12, 2013
Last updated
Apr 7, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F338183 NY
Registered Nurse 163W00000X 630917 NY Primary

Addresses

Primary practice location

100 High St
Buffalo, NY 14203-1126

Mailing address

100 High St
Buffalo, NY 14203-1126
Phone (716) 983-9853

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
I20170713000042 NY Practitioner - Nurse Practitioner 4486953676 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
630917NYMDRegistered Nurse
F338183NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kaleida Health CurrentSince Feb 15, 2018 Accepting new patients
Kaleida Health Current Accepting new patients
Kaleida Health CurrentSince Feb 15, 2018 Accepting new patients

Locations

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

100 High St
#13282
Buffalo, NY 14203

100 High St
#B2
Buffalo, NY 14203
Phone (716) 859-1256

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

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459987200000",
    "number": "1356782742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HIGH ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031126",
            "telephone_number": "716-983-9853"
        },
        {
            "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": "716-859-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAYNOR",
        "first_name": "MARY",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-12",
        "last_updated": "2016-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F338183",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "630917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.