NPIMap

Individual provider Active NPI

Elizabeth Kidder, MD

  • Internal Medicine Physician
  • Jamestown, NY
National Provider Identifier
1407276587
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
288860 Issued in NY
Practice address
107 Institute St
Jamestown, NY 14701-6628
Phone
(716) 484-4334
Fax
(833) 974-1992
NPI assigned
Apr 16, 2014
Last updated
Apr 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 288860 NY Primary

Addresses

Primary practice location

107 Institute St
Jamestown, NY 14701-6628

Mailing address

107 Institute St
Jamestown, NY 14701-6628
Phone (716) 484-4334

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address elizabeth.kidder.1@22211.direct.athenahealth.com Direct

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
I20181109000039 NY Practitioner - Internal Medicine 9436451283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
George Washington University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Chautauqua Center IncGroup PAC ID 7214178326, 35 clinicians

Practice addresses (Care Compare)

107 Institute St
Jamestown, NY 14701-6628
Phone (716) 363-6050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
288860NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Chautauqua Center, Inc CurrentSince Sep 24, 2018 Accepting new patients
Chautauqua PT OT & SLP Professionals PLLC Past Accepting new patients
County of Chautauqua - a Mun Corp Past Accepting new patients

Locations

1134 Central Ave
Dunkirk, NY 14048
Phone (716) 366-6036

319 Central Ave
Ste B
Dunkirk, NY 14048

107 Institute St
Jamestown, NY 14701
Phone (716) 484-4334

110 E 4th St
Jamestown, NY 14701
Phone (716) 484-4334

Interoperability endpoints

  • Direct secure messaging: elizabeth.kidder.1@22211.direct.athenahealth.com
  • Direct secure messaging: elizabeth.kidder.1@26367.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
The Chautauqua Center IncElmira, NY, CCN 571924 Federally qualified health center Corporate Officer
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)		 Aug 1, 2025
Aug 1, 2025
Aug 1, 2025
The Chautauqua Center IncGowanda, NY, CCN 571942 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Oct 1, 2025
Oct 2, 2017

Owned or controlled facilities with NPI records 2

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

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.

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": "1397606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1407276587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 INSTITUTE ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016628",
            "telephone_number": "716-484-4334",
            "fax_number": "833-974-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 INSTITUTE ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016628",
            "telephone_number": "716-484-4334",
            "fax_number": "833-974-1992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDDER",
        "first_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-16",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "288860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "elizabeth.kidder.1@22211.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "107 Institute St",
            "city": "Jamestown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "147016628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jamestown, NY

Sources for this page

Verify at the official NPI Registry.