NPIMap

Individual provider Active NPI

Angel M Szkutak, P.A.

  • Physician Assistant
  • Derby, NY
National Provider Identifier
1407129109
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
015464 Issued in NY
Practice address
7060 Erie Rd
Derby, NY 14047-9430
Phone
(716) 947-0408
NPI assigned
Feb 12, 2012
Last updated
Oct 27, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 015464 NY Primary

Addresses

Primary practice location

7060 Erie Rd
Derby, NY 14047-9430

Mailing address

7060 Erie Rd
Derby, NY 14047-9430
Phone (716) 947-0408

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
I20120329000015 NY Practitioner - Physician Assistant 7113187105 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Family Medicine Assoc PCGroup PAC ID 8527031988, 3 clinicians

Practice addresses (Care Compare)

10626 Main St
North Collins, NY 14111-9550
Phone (716) 337-2422

7060 Erie Rd
Suite 100
Derby, NY 14047-9306

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
015464NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
General Physician, PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: aszkutak@lakeshorefamily.medentdirect.com

Organizations & group practices 2

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1329004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1407129109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7060 ERIE RD",
            "city": "DERBY",
            "state": "NY",
            "postal_code": "140479430",
            "telephone_number": "716-947-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7060 ERIE RD",
            "city": "DERBY",
            "state": "NY",
            "postal_code": "140479430",
            "telephone_number": "716-947-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SZKUTAK",
        "first_name": "ANGEL",
        "middle_name": "M",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-12",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, NY

Sources for this page

Verify at the official NPI Registry.