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

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 identifiers 1

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 58

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• 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
• John Joseph Bodkin III, MD

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

  • Urology Physician
  • Orchard Park, NY
  • NPI 1831538057
  NPD
• Mary Brooks, CRNA

  • Certified Registered Nurse Anesthetist
  • Jamestown, NY
  • NPI 1275598930
  NPD
• Valerie L Burkhard, M.D.

  • Urology Physician
  • Orchard Park, NY
  • NPI 1275709164
  NPD
• Mark D Chazen, M.D.

  • Urology Physician
  • Cheektowaga, NY
  • NPI 1518931989
  NPD
• Eric M Chevli, MD

  • Urology Physician
  • Buffalo, NY
  • NPI 1396365417
  NPD
• Elizabeth C Costanzo, DNP

  • Family Nurse Practitioner
  • Cheektowaga, NY
  • NPI 1841967395
  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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03869087",
            "state": "NY"
        }
    ],
    "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.