Individual provider Active NPI

Christopher Tyler Ewell

  • Physician Assistant
  • Rochester, NY
National Provider Identifier
1801645676
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
031967 Issued in NY
Practice address
1445 Portland Ave Ste 210
Rochester, NY 14621-3008
Phone
(585) 266-2010
NPI assigned
May 15, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 031967 NY Primary

Addresses

Primary practice location

1445 Portland Ave Ste 210
Rochester, NY 14621-3008

Mailing address

100 Kings Hwy S
Rochester, NY 14617-5504

Other practice location 1

1425 Portland Ave
Rochester, NY 14621-3011
Phone (585) 922-4000

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
I20240823002301 NY Practitioner - Physician Assistant 5395284269 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rochester General HospitalGroup PAC ID 0244149474, 1,192 clinicians

Practice addresses (Care Compare)

1415 Portland Ave
Rochester, NY 14621-3022

1425 Portland Ave
Rochester, NY 14621-3001
Phone (585) 922-4000

1425 Portland Ave
Rochester, NY 14621-3011
Phone (585) 922-4000

Hospital & facility affiliations

  • Rochester General Hospital Hospital, Rochester, NY, CCN 330125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
031967NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Western New York Medical Practice P.C CurrentSince Aug 19, 2024 Accepting new patients
Western New York Medical Practice P.C. CurrentSince Aug 19, 2024 Accepting new patients
Rochester General Hospital CurrentSince Aug 19, 2024 Accepting new patients
Rochester General Hospital CurrentSince Aug 19, 2024 Accepting new patients

Locations

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1445 Portland Ave
Ste 210
Rochester, NY 14621
Phone (585) 266-2010

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1801645676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KINGS HWY S",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146175504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 PORTLAND AVE STE 210",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213008",
            "telephone_number": "585-266-2010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1425 Portland Ave",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146213011",
            "country_code": "US",
            "telephone_number": "585-922-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EWELL",
        "first_name": "CHRISTOPHER",
        "middle_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "031967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.