Organization Active NPI

GJKS Physician, PC

  • Family Medicine Physician
  • Niagara Falls, NY
National Provider Identifier
1609583228
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GJKS PHYSICIAN, PC
Practice address
4515 Military Rd
Niagara Falls, NY 14305-1335
Phone
(716) 236-7880
Fax
(716) 236-7885
NPI assigned
Nov 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Authorized official

Name
Kaitlynn Lester
Title
Practice Manager
Phone
(716) 236-7880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4515 Military Rd
Niagara Falls, NY 14305-1335

Mailing address

4515 Military Rd
Niagara Falls, NY 14305-1335
Phone (716) 236-7880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230615000069 NY Part B Supplier - Clinic/Group Practice 6002274594 Receives reassigned benefits from 2 practitioners
Practice locations: Niagara Falls, 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
33D2285836GJKS Physician PC4515 Military Road Ste 1, Niagara Falls, NY 14305Certificate of waiverJul 18, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688601600000",
    "number": "1609583228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 MILITARY RD",
            "city": "NIAGARA FALLS",
            "state": "NY",
            "postal_code": "143051335",
            "telephone_number": "716-236-7880",
            "fax_number": "716-236-7885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 MILITARY RD",
            "city": "NIAGARA FALLS",
            "state": "NY",
            "postal_code": "143051335",
            "telephone_number": "716-236-7880",
            "fax_number": "716-236-7885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GJKS PHYSICIAN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-02",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A",
        "authorized_official_last_name": "LESTER",
        "authorized_official_first_name": "KAITLYNN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "716-236-7880"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niagara Falls, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; 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.