NPIMap

Organization Active NPI

Great Lakes Physician Practice PC

  • Internal Medicine Physician
  • Jamestown, NY
National Provider Identifier
1730599176
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
GREAT LAKES PHYSICIAN PRACTICE PC
Practice address
15 S Main St
Jamestown, NY 14701-6626
Phone
(716) 488-1877
Fax
(716) 488-1986
NPI assigned
May 7, 2014
Last updated
Feb 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Authorized official

Name
Patricia Devlin
Title
Sr.Director
Phone
(412) 432-7469

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Cardiovascular Disease Physician 207RC0000X NU
Gastroenterology Physician 207RG0100X NU
Nephrology Physician 207RN0300X NU
Pulmonary Disease Physician 207RP1001X NU
Obstetrics & Gynecology Physician 207V00000X NU
Orthopaedic Surgery Physician 207X00000X NU
Otolaryngology Physician 207Y00000X NU
Surgery Physician 208600000X NU

Addresses

Primary practice location

15 S Main St
Jamestown, NY 14701-6626

Mailing address

15 S Main St
Jamestown, NY 14701-6626
Phone (716) 488-1877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20141016000108 NY Part B Supplier - Clinic/Group Practice 6709007701 Receives reassigned benefits from 259 practitioners
Practice locations: Jamestown, NY; Silver Creek, NY; Salamanca, NY; Olean, NY; Hamburg, NY; Fredonia, NY; Dunkirk, NY; Cassadaga, NY
O20141231000644 PA Part B Supplier - Clinic/Group Practice 6709007701 Receives reassigned benefits from 8 practitioners
Practice locations: Bradford, PA; Coudersport, PA; Erie, PA; Warren, PA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0173900Great Lakes Physician Practice PC Dba GLPP15 S Main St - Suite 150, Jamestown, NY 14701Certificate of waiverMar 26, 2027
33D0956645Great Lakes Physician Practice PC Dba GLPP15 South Main St - Suite 150, Jamestown, NY 14701Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Locations

15 S Main St
Jamestown, NY 14701
Phone (607) 846-2030

15 S Main St
Ste 110
Jamestown, NY 14701
Phone (716) 483-2320

15 S Main St
Ste 150
Jamestown, NY 14701
Phone (716) 483-6700

15 S Main St
Ste 240
Jamestown, NY 14701
Phone (716) 483-0803

17 Sherman St
Ste 2000
Jamestown, NY 14701
Phone (716) 664-7558

116 Interstate Pkwy
Fl 4
Bradford, PA 16701
Phone (814) 362-8415

Practitioners & affiliated clinicians

Practitioners 293

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.

View all 293

NPI Registry JSON

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

{
    "created_epoch": "1399420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1730599176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S MAIN ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016626",
            "telephone_number": "716-488-1877",
            "fax_number": "716-488-1986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S MAIN ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016626",
            "telephone_number": "716-488-1877",
            "fax_number": "716-488-1986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICIAN PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-07",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "DEVLIN",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "SR.DIRECTOR",
        "authorized_official_telephone_number": "412-432-7469"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.