NPIMap

Organization Active NPI

East Aurora Pediatrics

  • Pediatric Adolescent Medicine Physician
  • East Aurora, NY
National Provider Identifier
1447212139
Registry record updated Jul 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
EAST AURORA PEDIATRICS
Practice address
94 Olean St
East Aurora, NY 14052-2531
Phone
(716) 652-0237
Fax
(716) 652-0983
NPI assigned
Apr 6, 2006
Last updated
Jul 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2010

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

Authorized official

Name
Barbara J Jordan
Title
Certified Medical Office Manager
Phone
(716) 652-0237

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X NY Primary

Addresses

Primary practice location

94 Olean St
East Aurora, NY 14052-2531

Mailing address

94 Olean St
East Aurora, NY 14052-2531
Phone (716) 652-0237

Other identifiers 6

IdentifierTypeStateIssuer
1124023650OtherNYPNP
1437121480OtherNYMD
1982609491OtherNYMD
1528063039OtherNYMD
1568467090OtherNYMD
1417952920OtherNYPNP

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0168876East Aurora Pediatrics PC94 Olean Street, Suite 210, East Aurora, NY 14052Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Locations

94 Olean St
Ste 210
East Aurora, NY 14052
Phone (716) 652-0237

Practitioners & affiliated clinicians

Practitioners 10

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": "1144281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279584000000",
    "number": "1447212139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 OLEAN ST",
            "city": "EAST AURORA",
            "state": "NY",
            "postal_code": "140522531",
            "telephone_number": "716-652-0237",
            "fax_number": "716-652-0983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 OLEAN ST",
            "city": "EAST AURORA",
            "state": "NY",
            "postal_code": "140522531",
            "telephone_number": "716-652-0237",
            "fax_number": "716-652-0983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST AURORA PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-06",
        "last_updated": "2010-07-20",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CERTIFIED MEDICAL OFFICE MANAGER",
        "authorized_official_telephone_number": "716-652-0237"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PNP",
            "identifier": "1124023650",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD",
            "identifier": "1437121480",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD",
            "identifier": "1982609491",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD",
            "identifier": "1528063039",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD",
            "identifier": "1568467090",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PNP",
            "identifier": "1417952920",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Aurora, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.