NPIMap

Individual provider Active NPI

John J Bodkin II, M.D.

  • Family Medicine Physician
  • East Amherst, NY
National Provider Identifier
1609831536
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
131001 Issued in NY
Practice address
5667 Creekwood CT E
East Amherst, NY 14051-2369
Phone
(716) 689-1864
NPI assigned
Apr 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 131001 NY Primary

Addresses

Primary practice location

5667 Creekwood CT E
East Amherst, NY 14051-2369

Mailing address

5667 Creekwood CT E
East Amherst, NY 14051-2369
Phone (716) 689-1864

Other identifiers 1

IdentifierTypeStateIssuer
00637274MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110216000277 NY Practitioner - Family Practice 6507845161 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York at Buffalo School of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5667 Creekwood CT E
East Amherst, NY 14051-2369
Phone (716) 689-1864

Hospital & facility affiliations

  • Hospice Buffalo Inc Hospice, Cheektowaga, NY, CCN 331502
  • Kaleida Health Hospital, Buffalo, NY, CCN 330005
  • Canterbury Woods Nursing home, Williamsville, NY, CCN 335816

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
131001NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Highgate Medical Group Family Medicine CurrentSince Jul 1, 1966 Accepting new patients
John J Bodkin, II, MD, LLC Family Medicine CurrentSince Aug 17, 2024 Accepting new patients

Locations

3950 E Robinson Rd
Ste 305
West Amherst, NY 14228

1150 Youngs Rd
Ste 104
Williamsville, NY 14221
Phone (716) 636-7979

6255 Sheridan Dr
Ste 200
Williamsville, NY 14221
Phone (716) 636-7979

1150 Youngs Rd
Williamsville, NY 14221
Phone (716) 632-4696

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Canterbury WoodsWilliamsville, NY, CCN 335816 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2013
Apr 1, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1609831536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5667 CREEKWOOD CT E",
            "city": "EAST AMHERST",
            "state": "NY",
            "postal_code": "140512369",
            "telephone_number": "716-689-1864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5667 CREEKWOOD CT E",
            "city": "EAST AMHERST",
            "state": "NY",
            "postal_code": "140512369",
            "telephone_number": "716-689-1864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODKIN",
        "first_name": "JOHN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "131001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00637274",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Amherst, NY

Sources for this page

Verify at the official NPI Registry.