NPIMap

Organization Active NPI

Southgate Medical Group,LLP

  • Internal Medicine Physician
  • West Seneca, NY
National Provider Identifier
1487611927
Registry record updated Jul 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SOUTHGATE MEDICAL GROUP,LLP
Practice address
1026 Union Rd
West Seneca, NY 14224-3449
Phone
(716) 712-0851
Fax
(716) 712-0852
NPI assigned
Apr 27, 2006
Last updated
Jul 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2014

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

Authorized official

Name
Lisa Hoffman, M.D.NPI 1679550412
Title
President
Phone
(716) 712-0851

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1026 Union Rd
West Seneca, NY 14224-3449

Mailing address

1026 Union Rd
West Seneca, NY 14224-3449
Phone (716) 712-0851

Other identifiers 2

IdentifierTypeStateIssuer
02367504MedicaidNY
4748010001OtherDME MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031112000627 NY Part B Supplier - Clinic/Group Practice 7911810189 Receives reassigned benefits from 42 practitioners
Practice locations: East Aurora, NY; West Seneca, NY
O20111017000040 NY DME Supplier - Multi-Specialty - Physician 7911810189 Practice locations: West Seneca, NY

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
33D1007858Lancaster Southgate Medical Group LLP1026 Union Rd, West Seneca, NY 14224Provider-performed microscopyJan 2, 2027

National Provider Directory

National Provider Directory

Locations

380 Cleveland Dr
Buffalo, NY 14215
Phone (716) 712-0851

Practitioners & affiliated clinicians

Practitioners 57

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.

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406419200000",
    "number": "1487611927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 UNION RD",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142243449",
            "telephone_number": "716-712-0851",
            "fax_number": "716-712-0852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 UNION RD",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142243449",
            "telephone_number": "716-712-0851",
            "fax_number": "716-712-0852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHGATE MEDICAL GROUP,LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2014-07-27",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-712-0851",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02367504",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME MEDICARE",
            "identifier": "4748010001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Seneca, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.