NPIMap

Individual provider Active NPI

Jessica E Ogorchock-Congilosi, MD

  • Family Medicine Physician
  • Hamburg, NY
National Provider Identifier
1720221229
Registry record updated Feb 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
264071-1 Issued in NY
Practice address
4855 Camp Rd
Suite 100
Hamburg, NY 14075-2600
Phone
(716) 646-1084
NPI assigned
Apr 13, 2009
Last updated
Feb 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 264071-1 NY Primary

Addresses

Primary practice location

4855 Camp Rd
Suite 100
Hamburg, NY 14075-2600

Mailing address

4855 Camp Road
Suite 100
Hamburg, NY 14075
Phone (315) 591-0910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120530000327 NY Practitioner - Family Practice 5193988277 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York at Buffalo School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Primary Care Associates, LLPGroup PAC ID 9931013703, 13 clinicians

Practice addresses (Care Compare)

4855 Camp Rd
Suite 100
Hamburg, NY 14075-2600
Phone (716) 646-1084

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
264071-1NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Primary Care Associates LLP Family Medicine CurrentSince Jul 16, 2012 Accepting new patients

Locations

4855 Camp Rd
Ste 100
Hamburg, NY 14075
Phone (716) 646-1084

Interoperability endpoints

  • Direct secure messaging: jogorchock@lakeshorepca.medentdirect.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1239580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455840000000",
    "number": "1720221229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 CAMP ROAD",
            "address_2": "SUITE 100",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "14075",
            "telephone_number": "315-591-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 CAMP RD",
            "address_2": "SUITE 100",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140752600",
            "telephone_number": "716-646-1084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGORCHOCK-CONGILOSI",
        "first_name": "JESSICA",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-13",
        "last_updated": "2016-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "264071-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamburg, NY

Sources for this page

Verify at the official NPI Registry.