Michael Colin Riley

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

4811 Buckley Rd
Liverpool, NY 13088-3676

Phone

(315) 457-9966

NPI assigned

Sep 21, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: michaelriley@northeastpeds.medentdirect.com

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1629684030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 PARSONS RD",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 BUCKLEY RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883676",
            "telephone_number": "315-457-9966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 Parsons Rd",
            "address_purpose": "LOCATION",
            "city": "Camillus",
            "state": "NY",
            "postal_code": "130312125",
            "country_code": "US",
            "telephone_number": "315-484-6235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RILEY",
        "first_name": "MICHAEL",
        "middle_name": "COLIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-21",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven K Richardson, MS/CAS
• Jennifer Leigh Ridgeway, PHARM.D.
• Karen Ridgeway
• Kristin M Rielly
• Lauris Sean Rigdon, PT
• Ravyn N Rivera, ADVANCED CASAC
• Jennifer Robb, LMSW
• Robert D Zucker, DPM PC
• Robert E Todd MD PC
• Robert J Weiss MD PC

• Physician Assistant in Liverpool, NY
• Providers in Liverpool, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.