Individual provider Active NPI

Caitlyn Elizabeth Roberts, PA

  • Physician Assistant
  • Orchard Park, NY
National Provider Identifier
1457996357
Registry record updated Nov 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5959 Big Tree Rd Ste 108
Orchard Park, NY 14127-2291
Phone
(716) 204-3200
NPI assigned
Nov 14, 2019
Last updated
Nov 14, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2019

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 NU Primary

Addresses

Primary practice location

5959 Big Tree Rd Ste 108
Orchard Park, NY 14127-2291

Mailing address

4225 Genesee St
Cheektowaga, NY 14225-1994
Phone (716) 204-3200

Other identifiers 1

IdentifierTypeStateIssuer
024440OtherNYNYS OFFICE OF PROFESSIONS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191219001450 NY Practitioner - Physician Assistant 7012341332 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
024440NYMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
University Orthopaedic Services Inc. CurrentSince Dec 2, 2019 Accepting new patients

Locations

160 Farber Hall
Buffalo, NY 14214
Phone (716) 829-2070

5959 Big Tree Rd
Ste 108
Orchard Park, NY 14127
Phone (716) 810-7997

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.

NPI Registry JSON

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

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573689600000",
    "number": "1457996357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 GENESEE ST",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142251994",
            "telephone_number": "716-204-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5959 BIG TREE RD STE 108",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141272291",
            "telephone_number": "716-204-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "CAITLYN",
        "middle_name": "ELIZABETH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-14",
        "last_updated": "2019-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS OFFICE OF PROFESSIONS",
            "identifier": "024440",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orchard Park, NY

Sources for this page

Verify at the official NPI Registry.