Great Lakes Physician, PC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

GREAT LAKES PHYSICIAN, PC

Practice address

3085 Harlem Rd
Suite 350
Cheektowaga, NY 14225-2591

Phone

(716) 844-5000

Fax

(716) 844-5050

NPI assigned

Apr 26, 2006

Last updated

Apr 25, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

K Kent Chevli, M.D.NPI 1215934781

Title

Managing Physician

Phone

(716) 844-5600

Specialties & licenses 3

Addresses

Other names 1

• Western New York Urology Associates LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Great Lakes Physician, PC

  • Urology Physician
  • Cheektowaga, NY
  • NPI 1659310092

  O20150818004788

  Same enrollment

Locations

Practitioners 83

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• K Kent Chevli, M.D.

  • Urology Physician
  • Cheektowaga, NY
  • NPI 1215934781
  NPD Authorized official
• David J. Abramowitz, M.D.

  • Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
  • Cheektowaga, NY
  • NPI 1265850390
  NPD
• Philip J Aliotta, M.D.

  • Urology Physician
  • Cheektowaga, NY
  • NPI 1760455356
  NPD
• Eric David Arnone, M.D.

  • Urology Physician
  • Jamestown, NY
  • NPI 1447578943
  NPD
• John Steven Barlog, MD

  • Urology Physician
  • Cheektowaga, NY
  • NPI 1629633714
  NPD
• Kirsten Bishop, PA

  • Surgical Physician Assistant
  • Jamestown, NY
  • NPI 1134162043
  NPD
• John Joseph Bodkin III, MD

  • Urology Physician
  • Cheektowaga, NY
  • NPI 1144464942
  NPD
• Matthew Sean Brennan, DO

  • Urology Physician
  • Orchard Park, NY
  • NPI 1831538057
  NPD
• Michael M Brogan, PA

  • Physician Assistant
  • Cheektowaga, NY
  • NPI 1467730101
  NPD
• Mary Brooks, CRNA

  • Certified Registered Nurse Anesthetist
  • Jamestown, NY
  • NPI 1275598930
  NPD
• Shannon M Bunch, RPA-C

  • Urology Physician
  • Orchard Park, NY
  • NPI 1518902899
  NPD
• Valerie L Burkhard, M.D.

  • Urology Physician
  • Orchard Park, NY
  • NPI 1275709164
  NPD

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493078400000",
    "number": "1720045792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3085 HARLEM RD",
            "address_2": "SUITE 350",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142252591",
            "telephone_number": "716-844-5000",
            "fax_number": "716-844-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3085 HARLEM RD",
            "address_2": "SUITE 350",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142252591",
            "telephone_number": "716-844-5000",
            "fax_number": "716-844-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICIAN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2017-04-25",
        "status": "A",
        "authorized_official_last_name": "CHEVLI",
        "authorized_official_first_name": "K",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "716-844-5600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western New York Urology Associates LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Marcelle Grassi, MD
• Jennifer Gray, L.P.N.
• Ian Cameron Grayson, DDS, MMSC
• Great Lakes Dentistry
• Great Lakes Physician, PC
• Great Lakes Urology PLLC
• Greater Buffalo Spine Care P.C.
• Joseph M Greco, M.D.
• Green Cab Bny Inc
• Elizabeth Green, LPN

• Urology Physician in Cheektowaga, NY
• Providers in Cheektowaga, NY by specialty
• Urology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.