Individual provider Active NPI

Theresa Anne McDonough, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Williamsville, NY
National Provider Identifier
1720385891
Registry record updated Feb 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
336396 Issued in NY
Practice address
1540 Maple Rd
Williamsville, NY 14221-3647
Phone
(716) 568-6221
NPI assigned
Feb 24, 2011
Last updated
Feb 24, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 336396 NY Primary

Addresses

Primary practice location

1540 Maple Rd
Williamsville, NY 14221-3647

Mailing address

1540 Maple Rd
Williamsville, NY 14221-3647

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110502000217 NY Practitioner - Nurse Practitioner 2062697337 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
University at Buffalo Pathologists, Inc Current Accepting new patients
Kaleida Health CurrentSince Jun 9, 2019 Accepting new patients
Kaleida Health Current Accepting new patients
Kaleida Health CurrentSince Jun 9, 2019 Accepting new patients

Locations

100 High St
#13282
Buffalo, NY 14203

219 Bryant St
Buffalo, NY 14222
Phone (716) 878-7000

900 Hertel Ave
Buffalo, NY 14216
Phone (716) 871-1571

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

445 Tremont St
North Tonawanda, NY 14120
Phone (716) 690-2291

1540 Maple Rd
Williamsville, NY 14221
Phone (716) 568-3514

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298505600000",
    "number": "1720385891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 MAPLE RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 MAPLE RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213647",
            "telephone_number": "716-568-6221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONOUGH",
        "first_name": "THERESA",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-24",
        "last_updated": "2011-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "336396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.