NPIMap

Organization Active NPI

Wyoming County

  • Emergency Medicine Physician
  • Warsaw, NY
National Provider Identifier
1407060759
Registry record updated May 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
WYOMING COUNTY
Practice address
400 N Main St
Warsaw, NY 14569-1025
Phone
(585) 786-8940
Fax
(585) 786-1222
NPI assigned
May 9, 2007
Last updated
May 5, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
WYOMING COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 5, 2015

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

Authorized official

Name
Mr. Michael A. Corcimiglia
Title
Coo
Phone
(585) 786-8940

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary
Otolaryngology Physician 207Y00000X NU
Psychiatry Physician 2084P0800X NU
Surgery Physician 208600000X NU

Addresses

Primary practice location

400 N Main St
Warsaw, NY 14569-1025

Mailing address

143 N Main St
Warsaw, NY 14569-1100
Phone (585) 786-8940

Other identifiers 5

IdentifierTypeStateIssuer
00040514704OtherNYUNIVERA
03372245MedicaidNY
000525907002OtherNYBLUE CROSS
FA0944OtherNYPREFERRED CARE
70102AMedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040929001076 NY Part B Supplier - Clinic/Group Practice 9335118967 Receives reassigned benefits from 89 practitioners
7 other NPIs on this enrollment
Practice locations: Arcade, NY; Attica, NY; Perry, NY; Silver Springs, NY; Warsaw, NY

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
Part of
Wyoming County County of Wyoming

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wyoming CountyWarsaw, NY, CCN 331323 Hospital Operational/Managerial Control May 31, 2022
Wyoming CountyWarsaw, NY, CCN 33Z323 Hospital Operational/Managerial Control May 31, 2022
Wyoming CountyWarsaw, NY, CCN 33M323 Hospital Operational/Managerial Control May 31, 2022
Med TempsWarsaw, NY, CCN 335034 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jan 1, 1967
Jan 1, 1967
Healthcare Solutions Wny , LLCWarsaw, NY, CCN 333413 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 4, 2005
Wyoming CountyPerry, NY, CCN 338502 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2020
Wyoming County Family Medicine ArcadeArcade, NY, CCN 333422 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2020

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Wyoming County

    dba Wyoming County Community Hospital SNF

    • Skilled Nursing Facility
    • Warsaw, NY
    • NPI 1194702506

    5% Or Greater Direct Ownership Interest, Adp of the SNF

    CMS ownership
  • Wyoming County
    • Rural Acute Care Hospital
    • Warsaw, NY
    • NPI 1316924913

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 90

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 90

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1407060759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 N MAIN ST",
            "city": "WARSAW",
            "state": "NY",
            "postal_code": "145691100",
            "telephone_number": "585-786-8940",
            "fax_number": "585-786-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N MAIN ST",
            "city": "WARSAW",
            "state": "NY",
            "postal_code": "145691025",
            "telephone_number": "585-786-8940",
            "fax_number": "585-786-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYOMING COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WYOMING COUNTY",
        "enumeration_date": "2007-05-09",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "CORCIMIGLIA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "585-786-8940",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00040514704",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03372245",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000525907002",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "FA0944",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "70102A",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warsaw, NY

Sources for this page

Verify at the official NPI Registry.