Active NPI
Jon C Kucera, MD
- Internal Medicine Physician
- Buffalo, NY
National Provider Identifier
1447348776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 178475-1
- Practice address
- 155 Lawn Ave
Buffalo, NY 14207-1816 - Phone
- (716) 875-2904
- Fax
- (716) 875-6717
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 178475-1 | NY | Primary |
Addresses
Primary practice location
155 Lawn Ave
Buffalo, NY 14207-1816
Mailing address
155 Lawn Ave
Buffalo, NY 14207-1816
Phone (716) 875-2904
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01139880 | Medicaid | NY | |
| 0409803 | Other | NY | INDEPENDENT HEALTH |
| 040426002977 | Other | NY | FIDELIS |
| 000510823004 | Other | NY | BC/BS |
| 150520-BJ | Other | NY | PREFERRED CARE |
| 00010096302 | Other | NY | UNIVERA |
| 2593447 | Other | NY | GHI PPO |
| 72676 | Other | NY | GHI HMO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178475-1 | NY | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330646400000",
"number": "1447348776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 LAWN AVE",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142071816",
"telephone_number": "716-875-2904",
"fax_number": "716-875-6717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 LAWN AVE",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142071816",
"telephone_number": "716-875-2904",
"fax_number": "716-875-6717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUCERA",
"first_name": "JON",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2012-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "178475-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01139880",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENT HEALTH",
"identifier": "0409803",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS",
"identifier": "040426002977",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "000510823004",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE",
"identifier": "150520-BJ",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERA",
"identifier": "00010096302",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI PPO",
"identifier": "2593447",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI HMO",
"identifier": "72676",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.