Taylor J Indivero, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

1415 Portland Ave
Rochester, NY 14621-3038

Phone

(585) 922-2906

Fax

(585) 922-2951

NPI assigned

Sep 17, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Western New York Medical Practice PCGroup PAC ID 3870767791, 528 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tindivero133124@direct.rochesterregional.org

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.

• Western New York Medical Practice P.C.

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1063790608
  Medicare reassignment Care Compare group NPD
• Rochester General Hospital

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1356412712
  Medicare reassignment
• St Josephs Hospital Health Center

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1508815333
  Medicare reassignment
• St. Joseph'S Physician Health, P.C.

  • Anesthesiology Physician
  • Troy, NY
  • NPI 1154376770
  Medicare reassignment
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1255360517
  NPD
• St Joseph'S Hospital Health Center

  • Internal Medicine Physician
  • Syracuse, NY
  • NPI 1699832436

  Surgical

  NPD
• Western New York Medical Practice P.C

  • Urgent Care Clinic/Center
  • Rochester, NY
  • NPI 1154834877
  NPD

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393891200000",
    "number": "1700136777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213038",
            "telephone_number": "585-922-2906",
            "fax_number": "585-922-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213038",
            "telephone_number": "585-922-2906",
            "fax_number": "585-922-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INDIVERO",
        "first_name": "TAYLOR",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-17",
        "last_updated": "2014-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03726107",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Inclema
• Darlene A Inclema, RN
• Elizabeth Inclima
• Independent Living for Seniors - Fee for Service
• Katharina Mariah Indivero, PA-C
• Individual
• James J Infantino, DDS
• Rina Infantino, LPN
• Sheryl Ann Infantino
• Mary Beth Infantolino

• Surgical Physician Assistant in Rochester, NY
• Providers in Rochester, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.