Mark Alan Medakovich, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

647277 Issued in NY

Practice address

Elm and Carlton Streets
Buffalo, NY 14263-1104

Phone

(716) 845-2300

NPI assigned

Mar 20, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Roswell Park Cancer InstituteGroup PAC ID 3577475110, 487 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Roswell Park Cancer Institute Hospital, Buffalo, NY, CCN 330354

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Roswell Park Cancer Institute

  • Multi-Specialty Clinic/Center
  • Buffalo, NY
  • NPI 1720036593
  Medicare reassignment Care Compare group NPD
• Roswell Park Cancer Institute

  • Pharmacy
  • Williamsville, NY
  • NPI 1871379586
  NPD

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

• Roswell Park Cancer Institute

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1548315401
  Care Compare affiliation

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

{
    "created_epoch": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1780144410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 KETCHUM PL",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142132661",
            "telephone_number": "716-870-9108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ELM AND CARLTON STREETS",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142631104",
            "telephone_number": "716-845-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "665 Elm St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142031104",
            "country_code": "US",
            "telephone_number": "800-767-9355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDAKOVICH",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-20",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "647277",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "647277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE",
            "identifier": "647277",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Calvin James Meaney, PHARMD, BCPS
• Alexis Noelle Meara
• Morgan Catherine Mears, MS OTR/L
• Timothy Mecca
• Med-X Health Services
• Medcor Staffing Inc.
• Medfirst Urgent Care PLLC
• Medfirst Urgent Care PLLC
• Kristin Mediak
• Medical Practitioner Services of Wny PC

• Certified Registered Nurse Anesthetist in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Certified Registered Nurse Anesthetist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.