Individual provider Active NPI

Michael J Brown, PA

  • Medical Physician Assistant
  • Rochester, NY
National Provider Identifier
1508820119
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
000051 Issued in NY
Practice address
100 White Spruce Blvd
Dermatology Associates of Rochester PC
Rochester, NY 14623-1507
Phone
(585) 272-0700
Fax
(585) 697-0822
NPI assigned
Apr 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Medical Physician Assistant 363AM0700X 000051 NY Primary

Addresses

Primary practice location

100 White Spruce Blvd
Dermatology Associates of Rochester PC
Rochester, NY 14623-1507

Mailing address

1815 Clinton Ave S
Ste 530
Rochester, NY 14618-5721
Phone (585) 442-4310

Other identifiers 1

IdentifierTypeStateIssuer
BB2718MedicaidNY

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
I20111102000283 NY Practitioner - Physician Assistant 7012180318 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Duke University School of Medicine, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Helendale Dermatology and Medical Spa PLLCGroup PAC ID 6901870294, 6 clinicians

Practice addresses (Care Compare)

500 Helendale Rd
Suite 100
Rochester, NY 14609-3109
Phone (585) 266-5420

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000051NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Western New York Medical Practice, P.C. CurrentSince Mar 29, 2022 Accepting new patients
Western New York Medical Practice P.C. CurrentSince Mar 29, 2022 Accepting new patients
Rochester General Hospital Past Accepting new patients

Locations

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

601 Elmwood Ave
#320
Rochester, NY 14642

1815 S Clinton Ave
Ste 530
Rochester, NY 14618
Phone (585) 442-4310

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.

NPI Registry JSON

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1508820119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 CLINTON AVE S",
            "address_2": "STE 530",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146185721",
            "telephone_number": "585-442-4310",
            "fax_number": "585-442-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WHITE SPRUCE BLVD",
            "address_2": "DERMATOLOGY ASSOCIATES OF ROCHESTER PC",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146231507",
            "telephone_number": "585-272-0700",
            "fax_number": "585-697-0822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-12",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "000051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BB2718",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.