Kerry Widdersheim Graff, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

207638 Issued in NY

Practice address

502 S Main St
Lake Country Family Medicine
Canandaigua, NY 14424-2242

Phone

(585) 394-1875

Fax

(888) 990-2283

NPI assigned

Jun 8, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• Kerry Paige Widdersheim Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• The Frederick Ferris Thompson Hospital

  • Community/Retail Pharmacy
  • Victor, NY
  • NPI 1831914274
  NPD (past)

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1700827375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 S MAIN ST",
            "address_2": "LAKE COUNTRY FAMILY MEDICINE",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144242242",
            "telephone_number": "585-394-1875",
            "fax_number": "888-990-2283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 S MAIN ST",
            "address_2": "LAKE COUNTRY FAMILY MEDICINE",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144242242",
            "telephone_number": "585-394-1875",
            "fax_number": "888-990-2283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAFF",
        "first_name": "KERRY",
        "middle_name": "WIDDERSHEIM",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NY",
            "license": "207638",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "207638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNOW",
            "identifier": "000921058001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD",
            "identifier": "0520",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02048819",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS BC/BS AND CHP",
            "identifier": "P010207638",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "101717BF",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kerry.graff@rochesterregional.org",
            "affiliation": "N",
            "address_1": "502 S MAIN ST",
            "address_2": "LAKE COUNTRY FAMILY MEDICINE",
            "city": "Canandaigua",
            "state": "NY",
            "country_code": "US",
            "postal_code": "144242242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KERRY",
            "last_name": "WIDDERSHEIM",
            "middle_name": "PAIGE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Goodall I, LPN
• Colin P Gooley, SOCIAL WORKER
• Lisa Gordner, LCSW
• Frances Gouda, MHC
• Meredith Christine Grace, NP
• Kaitlin Graham, SLP
• Jonathan Grasso, PSY. D.
• Clayton Baron Green, M.D.,PH.D.
• Mary Onnolee Green, RN
• David Arleigh Gregor, LMT

• Family Medicine Physician in Canandaigua, NY
• Providers in Canandaigua, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.