Individual provider Active NPI

Christine Marie Micciariello, PHYSICIAN ASSISTANT

  • Medical Physician Assistant
  • Williamsville, NY
National Provider Identifier
1699896001
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
325 Essjay Rd
Williamsville, NY 14221-8243
Phone
(716) 631-2517
Fax
(716) 634-5650
NPI assigned
Apr 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 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 007098-1 NY
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

325 Essjay Rd
Williamsville, NY 14221-8243

Mailing address

425 Essjay Rd Ste 170
Williamsville, NY 14221-8235
Phone (716) 630-1219

Other names 1

  • Ms. Christine Marie Reynolds Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address production@direct.buffalomedicalgroup.com

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
I20051019000608 NY Practitioner - Physician Assistant 2961428966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Buffalo Medical Group, P.C.Group PAC ID 7012820301, 233 clinicians

Practice addresses (Care Compare)

2157 Main St
Buffalo, NY 14214-2648
Phone (716) 630-1000

2950 Elmwood Ave
Kenmore, NY 14217-1304
Phone (716) 630-1000

85 High St
Buffalo, NY 14203-1149
Phone (716) 630-1000

Hospital & facility affiliations

  • Sisters of Charity Hospital Hospital, Buffalo, NY, CCN 330078
  • Kenmore Mercy Hospital Hospital, Kenmore, NY, CCN 330102
  • Mount St. Mary'S Hospital & Health Center Hospital, Lewiston, NY, CCN 330188

Merit-based Incentive Payment System (MIPS)

Final score
91.31 of 100Reported as group
Quality
87.9
Promoting interoperability
100
Improvement activities
40
Cost
83.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
007098-1NYMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Buffalo Medical Group, P.C. CurrentSince Oct 1, 2005 Accepting new patients
Buffalo Medical Group, P.C. CurrentSince Oct 1, 2005 Accepting new patients
Surgical Associates of Western Ny PC Past Accepting new patients

Locations

85 High St
Buffalo, NY 14203
Phone (716) 857-8623

445 Tremont St
North Tonawanda, NY 14120
Phone (716) 690-2291

6255 Sheridan Dr
Ste 304
Williamsville, NY 14221
Phone (716) 857-8666

425 Essjay Rd
Ste 170
Williamsville, NY 14221
Phone (716) 630-1219

9 Limestone Dr
Williamsville, NY 14221
Phone (716) 626-4200

325 Essjay Rd
Williamsville, NY 14221
Phone (716) 630-1102

325 Essjay Rd
Ste 170
Williamsville, NY 14221
Phone (716) 603-1341

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/457/brand/1/csg/1/fhir/r4
  • Direct secure messaging: production@direct.buffalomedicalgroup.com

Organizations & group practices 3

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 4

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": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1699896001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 ESSJAY RD STE 170",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142218235",
            "telephone_number": "716-630-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 ESSJAY RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142218243",
            "telephone_number": "716-631-2517",
            "fax_number": "716-634-5650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICCIARIELLO",
        "first_name": "CHRISTINE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "007098-1",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "production@direct.buffalomedicalgroup.com",
            "affiliation": "N",
            "address_1": "325 Essjay Rd",
            "city": "Williamsville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "142218243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "REYNOLDS",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "PHYSICIAN ASSISTANT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.