Nicole Maria Antzoulides Conroe, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

013201 Issued in NY

Practice address

3680 Eggert Rd
Orchard Park, NY 14127-1963

Phone

(716) 662-5357

Fax

(716) 662-2774

NPI assigned

Mar 30, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Nicole Maria Antzoulides Former name

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

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Academic Medicine Services, Inc.Group PAC ID 0941105241, 115 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaleida Health Hospital, Buffalo, NY, CCN 330005

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

• Academic Medicine Services, Inc.

  • Internal Medicine Physician
  • Williamsville, NY
  • NPI 1255394763
  Medicare reassignment Care Compare group
• Buffalo Emergency Associates LLP

  • Emergency Medicine Physician
  • Williamsville, NY
  • NPI 1508816521
  Medicare reassignment

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

• Kaleida Health

  • General Acute Care Hospital
  • Williamsville, NY
  • NPI 1053441907
  Care Compare affiliation
• Kaleida Health

  • General Acute Care Hospital
  • North Tonawanda, NY
  • NPI 1104956358
  Care Compare affiliation
• Kaleida Health

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1245365196
  Care Compare affiliation
• Kaleida Health

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1366473183
  Care Compare affiliation
• Kaleida Health

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1639209596
  Care Compare affiliation
• Kaleida Health

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1831229780
  Care Compare affiliation

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

{
    "created_epoch": "1238371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612742400000",
    "number": "1740422336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3680 EGGERT RD",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3680 EGGERT RD",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271963",
            "telephone_number": "716-662-5357",
            "fax_number": "716-662-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTZOULIDES CONROE",
        "first_name": "NICOLE",
        "middle_name": "MARIA",
        "name_prefix": "Ms.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-30",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "013201-1",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE",
            "identifier": "013201",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "ANTZOULIDES",
            "middle_name": "MARIA",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kenneth Florian Andrus
• Heather Andrzejewski, RPA-C
• Kim Marie Ankenbauer, OTR/L
• Anthony Brown Pharmacy Inc
• Anthony Brown Pharmacy Inc
• Sonya Reanea Richburg Anzalone, MA
• Mary F Arlow, NP
• Tahereh Arnold
• Stephen Eugene Aszkler, D.D.S.
• Thomas A. Augustine, MD

• Physician Assistant in Orchard Park, NY
• Providers in Orchard Park, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.