Individual provider Active NPI

Nathan C Wolcott, PA-C

  • Physician Assistant
  • Cheektowaga, NY
National Provider Identifier
1629625173
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
027786 Issued in NY
Practice address
4225 Genesee St Ste 400
Cheektowaga, NY 14225-1994
Phone
(716) 204-3200
Fax
(716) 204-4337
NPI assigned
Aug 20, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2021

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 OA005029 PA
Physician Assistant 363A00000X 027786 NY Primary

Addresses

Primary practice location

4225 Genesee St Ste 400
Cheektowaga, NY 14225-1994

Mailing address

4225 Genesee St
Ste 400
Cheektowaga, NY 14225-1994
Phone (716) 906-5908

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
I20220104001361 NY Practitioner - Physician Assistant 1052743986 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
027786NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
University Orthopaedic Services, Inc CurrentSince Dec 23, 2021 Accepting new patients
Mount Nittany Medical Center Health Services Inc CurrentSince Sep 30, 2019 Accepting new patients
University Orthopaedic Services Inc. CurrentSince Dec 23, 2021 Accepting new patients
Martin & Suhey Orthopedics, P.C. CurrentSince Aug 1, 2019 Accepting new patients

Locations

160 Farber Hall
Buffalo, NY 14214
Phone (716) 829-2070

4225 Genesee St
Ste 400
Cheektowaga, NY 14225
Phone (716) 906-5905

141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322

1700 Old Gatesburg Rd
Ste 200
State College, PA 16803
Phone (814) 237-4321

1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800

Organizations & group practices 6

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": "1566259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1629625173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 GENESEE ST",
            "address_2": "STE 400",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142251994",
            "telephone_number": "716-906-5908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 GENESEE ST STE 400",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142251994",
            "telephone_number": "716-204-3200",
            "fax_number": "716-204-4337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLCOTT",
        "first_name": "NATHAN",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-20",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA005029",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "027786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheektowaga, NY

Sources for this page

Verify at the official NPI Registry.