NPIMap

Organization Active NPI

Gary T Brotherson MD Inc

Doing business as Niagara Eye Associates

  • Ophthalmology Physician
  • Erie, PA
National Provider Identifier
1497788087
Registry record updated Jan 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD030604E Issued in PA
Legal business name
GARY T BROTHERSON MD INC
Doing business as
Niagara Eye Associates
Practice address
1801 W 8TH St
Erie, PA 16505-4938
Phone
(814) 455-8004
Fax
(814) 456-6054
NPI assigned
Jul 8, 2006
Last updated
Jan 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2011

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

Authorized official

Name
Mrs. Lori Piscitelli
Title
Billing Admin.
Phone
(814) 455-8004

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X MD030604E PA Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X OS010267L PA

Addresses

Primary practice location

1801 W 8TH St
Erie, PA 16505-4938

Mailing address

1801 W 8TH St
Erie, PA 16505-4938
Phone (814) 455-8004

Other names 1

  • Niagara Eye Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050414000683 PA Part B Supplier - Clinic/Group Practice 6406893056 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Erie, PA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Gary T Brotherson MD Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295568000000",
    "number": "1497788087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054938",
            "telephone_number": "814-455-8004",
            "fax_number": "814-456-6054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054938",
            "telephone_number": "814-455-8004",
            "fax_number": "814-456-6054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY T BROTHERSON MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2011-01-21",
        "status": "A",
        "authorized_official_last_name": "PISCITELLI",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "BILLING ADMIN.",
        "authorized_official_telephone_number": "814-455-8004",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD030604E",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "OS010267L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Niagara Eye Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.