Individual provider Active NPI

Eric John Breitwieser, RPA-C

  • Physician Assistant
  • Buffalo, NY
National Provider Identifier
1518106251
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
013126 Issued in NY
Practice address
Elm and Carlton Streets
Buffalo, NY 14263
Phone
(716) 845-2300
Fax
(716) 845-3423
NPI assigned
Feb 19, 2009
Last updated
Jun 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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 013126 NY Primary
Medical Physician Assistant 363AM0700X 013126 NY

Addresses

Primary practice location

Elm and Carlton Streets
Buffalo, NY 14263

Mailing address

Elm and Carlton Streets
Buffalo, NY 14263-0001
Phone (716) 845-2300

Other identifiers 1

IdentifierTypeStateIssuer
03083438MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
013126NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Roswell Park Cancer Institute CurrentSince Sep 20, 2012 Accepting new patients

Locations

Dept 8000
Buffalo, NY 14267

Elm and Carlton St
Buffalo, NY 14263

Organizations & group practices 1

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": "1235001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1518106251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ELM AND CARLTON STREETS",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142630001",
            "telephone_number": "716-845-2300",
            "fax_number": "716-845-3423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ELM AND CARLTON STREETS",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14263",
            "telephone_number": "716-845-2300",
            "fax_number": "716-845-3423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREITWIESER",
        "first_name": "ERIC",
        "middle_name": "JOHN",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-19",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013126",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "013126",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03083438",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.