NPIMap

Individual provider Active NPI

Shelby Miranda Hall, PA-C

  • Physician Assistant
  • Tonawanda, NY
National Provider Identifier
1386111433
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
025325 Issued in NY
Practice address
1430 Colvin BVLD
Tonawanda, NY 14223
Phone
(716) 874-4060
NPI assigned
Oct 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 025325 NY Primary

Addresses

Primary practice location

1430 Colvin BVLD
Tonawanda, NY 14223

Mailing address

726 Exchange St Ste 710
Buffalo, NY 14210-1464
Phone (716) 852-4772

Other practice location 1

1283 Penora Street
Depew, NY 14043
Phone (716) 247-1973

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200908002724 NY Practitioner - Physician Assistant 5890113831 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
General Physician PCGroup PAC ID 9537213079, 488 clinicians

Practice addresses (Care Compare)

1430 Colvin Blvd
Buffalo, NY 14223-1440
Phone (716) 874-4060

3898 Vineyard Dr
Dunkirk, NY 14048-3559
Phone (716) 710-8266

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.78 of 100Reported as group
Quality
87.1
Promoting interoperability
95
Improvement activities
40
Cost
86.98

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
025325NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
General Physician, PC CurrentSince Dec 1, 2024 Accepting new patients
University at Buffalo Neurosurgery, Inc. CurrentSince Sep 1, 2020 Accepting new patients
University at Buffalo Neurosurgery, Inc. CurrentSince Sep 1, 2020 Accepting new patients

Locations

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

726 Exchange St
Ste 710
Buffalo, NY 14210
Phone (716) 343-3016

40 George Karl Blvd
Williamsville, NY 14221
Phone (716) 539-0888

Interoperability endpoints

  • Direct secure messaging: shall@gppc.medentdirect.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1540512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1386111433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 EXCHANGE ST STE 710",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142101464",
            "telephone_number": "716-852-4772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 COLVIN BVLD",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "14223",
            "telephone_number": "716-874-4060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1283 Penora Street",
            "address_purpose": "LOCATION",
            "city": "Depew",
            "state": "NY",
            "postal_code": "14043",
            "country_code": "US",
            "telephone_number": "716-247-1973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALL",
        "first_name": "SHELBY",
        "middle_name": "MIRANDA",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-26",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "025325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tonawanda, NY

Sources for this page

Verify at the official NPI Registry.