Individual provider Active NPI

Jack Matthew Seelbach, PA-C

  • Physician Assistant
  • Lewiston, NY
National Provider Identifier
1477437846
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
034141 Issued in NY
Practice address
5290 Military Rd Ste 8
Lewiston, NY 14092-1953
Phone
(716) 298-8440
NPI assigned
Jul 31, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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 034141 NY Primary

Addresses

Primary practice location

5290 Military Rd Ste 8
Lewiston, NY 14092-1953

Mailing address

190 Creekside Dr
Tonawanda, NY 14150-1421
Phone (716) 345-0910

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
I20251126003399 NY Practitioner - Physician Assistant 0042702904 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5290 Military Rd
Suite 8
Lewiston, NY 14092-1953
Phone (716) 298-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
034141NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mount St. Mary'S Hospital of Niagara Falls CurrentSince Oct 1, 2025 Accepting new patients
Mount St. Mary'S Hospital of Niagara Falls CurrentSince Oct 1, 2025 Accepting new patients
Mount St. Mary'S Hospital of Niagara Falls Physician Assistant Past Accepting new patients

Locations

5290 Military Rd
Ste 8
Lewiston, NY 14092
Phone (716) 297-9379

5300 Military Rd
Stela Niagara, NY 14092
Phone (716) 297-4800

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1753920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1477437846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 CREEKSIDE DR",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141501421",
            "telephone_number": "716-345-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5290 MILITARY RD STE 8",
            "city": "LEWISTON",
            "state": "NY",
            "postal_code": "140921953",
            "telephone_number": "716-298-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEELBACH",
        "first_name": "JACK",
        "middle_name": "MATTHEW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-31",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "034141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, NY

Sources for this page

Verify at the official NPI Registry.