NPIMap

Organization Active NPI

Upmc Chautauqua at Wca

Doing business as UPMC Chautauqua WCA

  • Psychiatry Physician
  • Jamestown, NY
National Provider Identifier
1386725182
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
UPMC CHAUTAUQUA AT WCA
Doing business as
UPMC Chautauqua WCA
Practice address
207 Foote Ave
Jamestown, NY 14701-7077
Phone
(716) 487-0141
NPI assigned
Oct 18, 2006
Last updated
Jan 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Authorized official

Name
Bradley Nelson Dinger
Title
Cfo
Phone
(814) 877-3739

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU
Substance Use Disorder Rehabilitation Hospital Unit 276400000X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

207 Foote Ave
Jamestown, NY 14701-7077

Mailing address

PO Box 840
207 Foote Ave.
Jamestown, NY 14702-0840
Phone (716) 485-7892

Other identifiers 1

IdentifierTypeStateIssuer
03169151MedicaidNY

Other names 2

  • UPMC Chautauqua WCA Doing business as
  • The Woman's Christian Association of Jamestown, N.Y. Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Healthynet

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040423000846 NY Part B Supplier - Clinic/Group Practice 4385630342 Receives reassigned benefits from 36 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dunkirk, NY; Jamestown, NY

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Albert J Persia4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

207 Foote Ave
Jamestown, NY 14701
Phone (716) 487-0141

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1386725182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840",
            "address_2": "207 FOOTE AVE.",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147020840",
            "telephone_number": "716-485-7892",
            "fax_number": "716-487-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 FOOTE AVE",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147017077",
            "telephone_number": "716-487-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPMC CHAUTAUQUA AT WCA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "DINGER",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "NELSON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-877-3739"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03169151",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Healthynet",
            "affiliation": "N",
            "address_1": "207 Foote Ave",
            "city": "Jamestown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "147017077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "UPMC Chautauqua WCA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Woman's Christian Association of Jamestown, N.Y.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "The Woman's Christian Association of Jamestown, N.Y.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jamestown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.